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Biomedical subjects

S Miller

Publications and source records attributed to S Miller.

At least 91 records · Page 5Linked to original sources
PubMed2001

Accuracy of cancer-risk assessment in primary care practice.

BACKGROUND: Primary care physicians (PCPs) are expected to play a central role in assessing cancer risk. This study was designed to evaluate how accurately PCPs would triage individuals at increased risk for cancer when presented with clinical vignettes. METHODS: Surveys evaluated practice demographics, attitudes, and responses to clinical scenarios. Answers were compared with guidelines and graded for consistency with the risk assessment. RESULTS: PCPs were inaccurate in assessing risk (p < 0.0001) and inconsistent in recommending screening (p < 0.001). Older physicians were more consistent (p < 0.02). No attitudinal bias was identified. CONCLUSION: Continuing education of PCPs is important for cancer-risk assessment and management.

Education, Medical, Continuing↗
PubMed2001

Mapping of IFN-beta epitopes important for receptor binding and biologic activation: comparison of results achieved using antibody-based methods and alanine substitution mutagenesis.

The epitopes important for receptor binding and activation of human interferon-beta1a (IFN-beta1a) were mapped with monoclonal antibodies (mAb), grouped on the basis of their specificity and ability to neutralize biologic activity, and alanine scanning mutagenesis (ASM). The binding properties of nine mAb were defined, using ASM-IFN-beta mutants having alanine substituted at targeted, surface-exposed residues. The results were correlated with the mAb neutralizing potency. Of six mAb that bound either at or adjacent to the IFNAR-2 receptor chain binding site defined by the ASM epitopes, only three had measurable neutralizing activity. Two of these inhibited IFN-beta/IFNAR-2 complex formation, suggesting that steric hindrance of receptor binding constitutes their mechanism of neutralization. However, two mAb that bound to sites remote from the IFNAR-2 binding site on IFN-beta also inhibited IFN-beta/IFNAR-2 complex formation and demonstrated potent neutralizing activity. Thus, neutralizing mAb may employ mechanisms other than steric blockade to inhibit directly the binding of receptor by cytokine, limiting their usefulness as tools to define precise receptor-ligand interaction sites.

Alanine↗
PubMed2001

Abnormal corticospinal function but normal axonal guidance in human L1CAM mutations.

L1 cell adhesion molecule (L1CAM) gene mutations are associated with X-linked 'recessive' neurological syndromes characterized by spasticity of the legs. L1CAM knock-out mice show hypoplasia of the corticospinal tract and failure of corticospinal axonal decussation and projection beyond the cervical spinal cord. The aim of this study was to determine if similar neuropathology underlies the spastic diplegia of males hemizygous for L1CAM mutations. Studies were performed on eight carrier females and 10 hemizygous males. Transcranial magnetic stimulation excited the corticospinal tract and responses were recorded in biceps brachii and quadriceps femoris. In contralateral biceps and quadriceps the responses had high thresholds and delayed onset compared with normal subjects. Ipsilateral responses in biceps were smaller, with higher thresholds and delayed onsets relative to contralateral responses. Subthreshold corticospinal conditioning of the stretch reflex of biceps and quadriceps was abnormal in both hemizygous males and carrier females suggesting there may also be a reduced projection to inhibitory interneurones. Histological examination of post-mortem material from a 2-week-old male with an L1CAM mutation revealed normal corticospinal decussation and axonal projections to lumbar spinal segments. These data support a role for L1CAM in corticospinal tract development in hemizygous males and 'carrier' females, but do not support a critical role for L1CAM in corticospinal axonal guidance.

Adolescent↗
PubMed2001

Ourselves, our bodies, our realities: an HIV prevention intervention for women with severe mental illness.

This paper describes a 10-session behavioral intervention introducing female-initiated methods of human immunodeficiency virus (HIV) prevention to reduce vulnerability to HIV infection for women with severe mental illness. In a pilot test of the intervention, 35 women were randomly placed in the experimental intervention group or an HIV education control. Subjective norms, intentions to use, perceived efficacy, and attitudes toward the male condom, female condom, and a microbicide were assessed at baseline, postintervention, and 6-week follow-up. The participants in the treatment group reported a significantly more positive attitude toward the use of female condoms (t = -2.12, P < .05) at 6-week follow-up. Providing women with severe mental illness with choices of protective methods and the knowledge and skills to ensure proper use are among the many crucial ingredients in prevention of acquired immunodeficiency syndrome.

Adult↗
PubMed2001

Linear growth characteristics of congenitally GH-deficient infants from birth to one year of age.

Birth length has been reported to be either normal or reduced in infants with congenital GH deficiency (CGHD). We evaluated 46 infants with CGHD followed in a single regional medical center. All were born full term and had peak GH of less than 10 microg/liter after provocative stimulation. Length SD score at birth was normal but subsequently showed deceleration, at 6 months and 12 months of age, before GH treatment. The majority were delivered vaginally (83%), and delivery was uncomplicated in 61%. Four patients (9%) had breech vaginal delivery. Perinatal morbidities were found in 72% of infants and included jaundice (n = 17), hypoglycemia with or without seizure (n = 14), and hypoxemia (n = 5). Multiple pituitary hormone deficiencies were found in 85% of the subjects. Organic lesions were documented in all 22 subjects who had magnetic resonance imaging and in 4 of 11 subjects who had computed tomography scan. Only the hypoglycemic infants received early GH treatment. Growth data in hypoglycemic and normoglycemic CGHD infants were not significantly different. In our population, CGHD did not adversely affect fetal growth but is essential for normal linear growth during early infancy. Congenital developmental abnormalities in the hypothalamic-pituitary region are the most common cause of CGHD and are best diagnosed by an magnetic resonance imaging study.

Aging↗
PubMed2001

MRI diagnosis of a previously undiagnosed large trabecular ventricular septal defect in an adult after multiple catheterizations and angiocardiograms.

Ventricular septal defect (VSD) is the most frequent congenital heart disease (25-30%). The diagnosis of VSD is usually made echocardiographically by means of colour Doppler ultrasound, and is confirmed by angiocardiography in most cases. We describe a case in which an additional large trabecular VSD was demonstrated by MRI after previous cardiac catheterizations and angiocardiography in various hospitals. MRI allows an exact presentation of the anatomy, including areas that are difficult to assess, for instance the apical septum. Determination of cardiac output, regurgitation volume and the Qp/Qs quotient in patients with shunt volume in heart defects is also possible with one examination.

Adult↗
PubMed2001

Identification and crystallisation of a heat- and protease-stable fragment of the bacteriophage T4 short tail fibre.

Irreversible binding of T-even bacteriophages to Escherichia coli is mediated by the short tail fibres, which serve as inextensible stays during DNA injection. Short tail fibres are exceptionally stable elongated trimers of gene product 12 (gp12), a 56 kDa protein. The N-terminal region of gp12 is important for phage attachment, the central region forms a long shaft, while a C-terminal globular region is implicated in binding to the bacterial lipopolysaccharide core. When gp12 was treated with stoichiometric amounts of trypsin or chymotrypsin at 37 degrees C, an N-terminally shortened fragment of 52 kDa resulted. If the protein was incubated at 56 degrees C before trypsin treatment at 37 degrees C, we obtained a stable trimeric fragment of 3 x 33 kDa lacking residues from both the N- and C-termini. Apparently, the protein unfolds partially at 56 degrees C, thereby exposing protease-sensitive sites in the C-terminal region and extra sites in the N-terminal region. Well-diffracting crystals of this fragment could be grown. Our results indicate that gp12 carries a stable central region, consisting of the C-terminal part of the shaft and the attached N-terminal half of the globular region. Implications for structure determination of the gp12 protein and its folding are discussed.

Amino Acid Sequence↗
PubMed2001

Expression and production of interleukin 4 in B-cell chronic lymphocytic leukaemia.

Interleukin (IL) 4 is a T-cell derived pleiotropic cytokine whose properties include alterations of B-cell function. In B-cell chronic lymphocytic leukaemia (B-CLL), IL4 is involved in the mechanism of survival of the leukaemic B-cells. The present study examines the expression and production of IL4 by B- and T-lymphocytes derived from patients with B-CLL and provides evidence that IL4 is not an autocrine factor in B-CLL. Freshly isolated B-CLL cells enriched for B- and T-cells did not express mRNA for IL4 but expressed mRNA for IL4 receptor (IL4R). Activation of B-cells with phorbol ester and calcium ionophore and of T-cells with phytohaemaglutinin (PHA) upregulated IL4 mRNA expression. However phorbol ester and calcium ionophore did not affect the mean level of IL4 production by either B-CLL or normal B-cells. Furthermore, in the presence or absence of activation, the amount of IL4 synthesised by B-CLL B-cells was not significantly different than that observed with peripheral blood B-cells isolated from normal individuals (with activation: P=0.239; without activation: P=0.565). Also, there was no significant difference between normal and B-CLL B-cells in the level of cytoplasmic IL4 (P=0.47). PHA-activated enriched B-CLL T-cells produced significantly higher levels of IL4 compared to normal control T-cells (P=0.0136). In addition, in 47% of cases with B-CLL T-cells, a significant higher level of intracellular IL4 was observed (P=0.0027). The levels of production of IL4 by the T-cell-enriched preparations correlated positively with the intensity of cytoplasmic L4 in CD4+ and CD8+ cells in tested samples (r=0.49 and r=0.76, respectively). The significant differences observed in the production of IL4 by B-CLL B- and T-lymphocytes may suggest a paracrine function of IL4 in B-CLL.

Adult↗
PubMed2001

Facilitating decision-making in young people.

A focus group discussion was used to investigate the ways in which children's nurses see themselves facilitating young people in decision making. This group of eight nurses expressed the view that young people should be involved in decisions about care and that in order for children's nurses to facilitate their decision-making, certain types of knowledge are needed to inform their interventions. Eraut's six categories of professional knowledge (Eraut 1994) were found to be useful in structuring their views. The nurses felt that they facilitated decision-making by knowing the individual and the context, by providing individuals with age-appropriate information and by taking account of ethical, legal and professional dimensions.

Adaptation, Psychological↗
PubMed2001

Selenite protects human endothelial cells from oxidative damage and induces thioredoxin reductase.

The ability of selenium to protect cultured human coronary artery endothelial cells (HCAEC), human umbilical vein endothelial cells (HUVEC) and bovine aortic endothelial cells (BAEC) from oxidative damage induced by 100 microM t-butyl hydroperoxide (t-BuOOH) was compared. Preincubation of human endothelial cells for 24 h with sodium selenite at concentrations as low as 5 nM provided significant protection against the harmful effects of 100 microM t-BuOOH, with complete protection being achieved with 40 nM selenite. The preincubation period was required for selenite to exert this protective effect on endothelial cells. When compared with selenium-deficient cells, the activities of cytoplasmic glutathione peroxidase (GPX-1), phospholipid hydroperoxide glutathione peroxidase (GPX-4) and thioredoxin reductase (TR) were each induced approx. 3--4-fold by 40 nM selenite. HCAEC and HUVEC showed great similarity in their relative abilities to resist oxidative damage in the presence and absence of selenite, and the activities of TR and the GPXs were also similar in these cell types. BAEC were more susceptible to damage by 100 microM t-BuOOH than were human endothelial cells, and could not be protected completely by incubation with selenite at concentrations up to 160 nM. The activity of TR in human endothelial cells was approx. 25-fold greater than that in BAEC of a similar selenium status, but GPX-1 and GPX-4 activities were not significantly different between the human and bovine cells. These studies, although performed with a small number of cultures, show for the first time that selenium at low doses can provide significant protection of the human coronary artery endothelium against damage by oxidative stress. TR may be an important antioxidant selenoprotein in this regard, in addition to the GPXs. The data also suggest that HUVEC, but not BAEC, represent a suitable model system in which to study the effects of selenium on the endothelium of human coronary arteries.

Animals↗
PubMed2001

Using a web-based prototype and human-computer interaction concepts to develop a vision for a next generation patient care management system.

This paper describes the novel use of two tools to develop requirements for a new generation patient care system: a web-based prototype and a human-computer interaction framework. These tools allowed a development team to crystallize new requirements for a patient care system, illustrate to clinicians a radical change in care process models, and begin the change management process in a large enterprise.

Hospital Information Systems↗
PubMed2001

First steps in developing a managed clinical network for vascular services in Lanarkshire.

AIM: To survey key personnel involved in setting up a Managed Clinical Network (MCN) for vascular services in Lanarkshire to assess their views, knowledge and understanding about networking, with a view to facilitating the implementation of the MCN. DESIGN: A questionnaire was designed covering current networking practice, use of protocols, audit and training. It was piloted with the MCN core group and extended to the wider steering group. Semi-structured interviews were completed with core group members focusing on the structure and management of the network. SETTING: Lanarkshire Health Board, Lanarkshire Acute Hospital Trust and Lanarkshire Primary Care Trust. SUBJECTS: The core group and steering group for the development of a Managed Clinical Network for Vascular Surgical Services. RESULTS: Clinicians tend to have more contacts with clinicians and managers with managers. There was close and frequent networking among clinicians of equal status. Respondents shared increased expectations for participation in audit, working to protocols, training and development and improved means of obtaining patients' views and providing information. All respondents recognised the necessity for network leadership although, in this study, it was not possible to define the style of leadership. CONCLUSION: This study identified a degree of existing, informal networking among members of the core group and steering group and it will be important to build on that foundation as the MCN develops. Further research is required to determine the most appropriate form of leadership for the network, and to identify, more clearly, what is understood by a managed network and what accountability there should be.

Attitude of Health Personnel↗
PubMed2000

The N terminus of p53 regulates its dissociation from DNA.

It is important to gain insight into p53 DNA binding and how it is regulated. By using electrophoretic mobility shift assays and DNase I footprinting, we show that a region within the N terminus of the protein controls the dissociation of p53 from a p53-binding site. When p53 is bound by a number of N-terminal-specific monoclonal antibodies, its rate of dissociation from DNA is reduced, and its ability to protect a cognate site from DNase I digestion is increased. Moreover, greatly reduced dissociation is observed with p53 protein lacking the N-terminal 96 amino acids. By contrast, deletion of the C terminus does not affect p53 dissociation from DNA or DNase I protection. p53 protein expressed in and purified from bacterial cells displays markedly more instability on its consensus DNA-binding site than does p53 produced in insect cells, suggesting that post-translational modifications may affect the stability of the protein. Our results provide evidence that the N terminus of p53 possesses an auto-inhibitory function that is mechanistically different from the inhibitory region at the C terminus.

Amino Acid Sequence↗
PubMed2000

Reversed-phase high-performance liquid chromatography combined with on-line UV diode array, FT infrared, and 1H nuclear magnetic resonance spectroscopy and time-of-flight mass spectrometry: application to a mixture of nonsteroidal antiinflammatory drugs.

A prototype multiply hyphenated system has been applied to the analysis of a mixture of nonsteroidal antiinflammatory drugs separated by reversed-phase HPLC. Characterization of the model NSAIDs was achieved via a combination of diode array UV, 1H NMR, FT-IR spectroscopy, and time-of-flight mass spectrometry. This combination of spectrometers allowed the collection of UV, 1H NMR, IR, and mass spectra together with atomic composition data enabling almost complete structural characterization to be performed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Systematic mutational mapping of sites on human interferon-beta-1a that are important for receptor binding and functional activity.

A systematic mutational analysis of human interferon-beta-1a (IFN-beta) was performed to identify regions on the surface of the molecule that are important for receptor binding and for functional activity. The crystal structure of IFN-beta-1a was used to design a panel of 15 mutant proteins, in each of which a contiguous group of 2-8 surface residues was mutated, in most instances to alanine. The mutants were analyzed for activity in vitro in antiviral and in antiproliferation assays, and for their ability to bind to the type I IFN (ifnar1/ifnar2) receptor on Daudi cells and to a soluble ifnar2 fusion protein (ifnar2-Fc). Abolition of binding to ifnar2-Fc for mutants A2, AB1, AB2, and E established that the ifnar2 binding site on IFN-beta comprises parts of the A helix, the AB loop, and the E helix. Mutations in these areas, which together define a contiguous patch of the IFN-beta surface, also resulted in reduced affinity for binding to the receptor on cells and in reductions in activity of 5-50-fold in functional assays. A second receptor interaction site, concluded to be the ifnar1 binding site, was identified on the opposite face of the molecule. Mutations in this region, which encompasses parts of the B, C, and D helices and the DE loop, resulted in disparate effects on receptor binding and on functional activity. Analysis of antiproliferation activity as a function of the level of receptor occupancy allowed mutational effects on receptor activation to be distinguished from effects on receptor binding. The results suggest that the binding energy from interaction of IFN-beta with ifnar2 serves mainly to stabilize the bound IFN/receptor complex, whereas the binding energy generated by interaction of certain regions of IFN-beta with ifnar1 is not fully expressed in the observed affinity of binding but instead serves to selectively stabilize activated states of the receptor.

Alanine↗