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Biomedical subjects

W J Harris

Publications and source records attributed to W J Harris.

At least 55 records · Page 3Linked to original sources

Efficient generation of a reshaped human mAb specific for the alpha toxin of Clostridium perfringens.

We have used the technique of antibody reshaping to produce a humanized antibody specific for the alpha toxin of Clostridium perfringens. The starting antibody was from a mouse hybridoma from which variable (V) region nucleotide sequences were determined. The complementarity-determining regions (CDRs) from these V regions were then inserted into human heavy and light chain V region genes with human constant region gene fragments subsequently added. The insertion of CDRs alone into human frameworks did not produce a functional reshaped antibody and modifications to the V region framework were required. With minor framework modifications, the affinity of the original murine mAb was restored and even exceeded. Where affinity was increased, an altered binding profile to overlapping peptides was observed. Computer modelling of the reshaped heavy chain V regions suggested that amino acids adjacent to CDRs can either contribute to, or distort, CDR loop conformation and must be adjusted to achieve high binding affinity.

Amino Acid Sequence↗

Initial experience with the Boyle uterine elevator.

Since 1990, our institution has used the Boyle uterine elevator in 57 abdominal hysterectomies. The device aids in retraction of the uterus and minimizes the use of self-retaining retractors and bowel packing. The uterine elevator also aids in dissection of the bladder and incision of the cardinal and uterosacral ligaments. The mean hospital stay has been reduced to 2.6 days. Postoperative complications are rare. We conclude that this device is a useful adjunct in the performance of abdominal hysterectomy.

Equipment Design↗

Humanized antibodies.

Hybridoma technology enabled rodent monoclonal antibodies to be created against human pathogens and cells, but these had limited clinical utility. Protein engineering, reviewed her by Greg Winter and William Harris, is now generating antibodies for treatment of infectious disease, autoimmune disease and cancer by 'humanizing' rodent antibodies. Humanized antibodies have improved pharmacokinetics, reduced immunogenicity and have been used to clinical advantage.

Animals↗

Humanized antibodies.

Hybridoma technology enabled rodent monoclonal antibodies to be created against human pathogens and cells, but these had limited clinical utility. Protein engineering is now generating antibodies for treatment of infectious disease, autoimmune disease and cancer by 'humanizing' rodent antibodies. Humanized antibodies have improved pharmacokinetics, reduced immunogenicity and have been used to clinical advantage.

Animals↗

Total knee arthroplasty without patellar resurfacing. Clinical outcomes and long-term follow-up evaluation.

Total knee arthroplasty (TKA) without resurfacing of the patella by a single surgeon was reviewed retrospectively in 125 patients: 66 patients (79 knees) were included in the final study group, 32 patients were deceased, 13 were without current address and not able to be contacted, and 14 patients were unable to complete a questionnaire because of severe illness or language barrier. All patients had a diagnosis of osteoarthrosis. The decision to leave the patella unresurfaced was based on the presence of satisfactory patellar articular cartilage, absence of eburnated bone, congruent patellofemoral tracking, normal anatomic patellar shape, and no evidence of crystalline disease or an inflammatory synovitis. A lateral retinacular release was performed in 13 knees (16.5%) to facilitate congruent patellar tracking. The follow-up period averaged 7.5 years (range, 2.4-15.5 years). There were no component revisions and no reoperations. The mean Knee Society score improved from 23.2 to 89.9 postoperatively and the function score improved from 58.4 to 92.0 postoperatively. Mild anterior knee pain was reported in 19%. Satisfaction with the surgical result was expressed in 89.5% of patients; 4% were somewhat satisfied; 2.6% were somewhat dissatisfied; and 4% were neutral. Of the patients who had mixed bilateral TKA (one TKA with unresurfaced patella, the other resurfaced), 46% rated both as equal; 46% preferred the TKA with the resurfaced patella; and 7.7% preferred the unresurfaced patella. In patients meeting the selection criteria outlined above, TKA without resurfacing of the patella provided satisfactory long-term results and a high degree of patient satisfaction with an absence of mechanical complications and no reoperations at the average 7.5-year follow-up evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Methods for assessing condition-specific and generic functional status outcomes after total knee replacement.

Many assume that, relative to generic measures, condition-specific health measures are both more sensitive to the condition's severity and more specific because they are less affected by other conditions. We analyzed the sensitivity and specificity of the generic SF-36, condition-specific scales based on the SF-36, and condition-specific measures based on the Knee Society's Clinical Rating System in a study of osteoarthritis patients following knee replacement. As hypothesized, knee-specific role function and pain measures were more specific than generic measures among patients with other comorbid conditions, and less so among patients with only knee problems. Physical function scales of both types were equally specific. Clinical indicators based on x-ray and range of motion were only weakly related to all measures of function.

Activities of Daily Living↗

Uterine dehiscence following laparoscopic myomectomy.

BACKGROUND: Laparoscopic myomectomy is a new procedure that is growing in popularity. The natural history of pregnancy following laparoscopic myomectomy is unknown. CASE: A 24-year-old white woman, gravida 0, with infertility and endometriosis, conceived after a laparoscopic procedure that included myomectomy. At 34 weeks' gestation, the patient experienced uterine dehiscence at the site of myomectomy. An emergency cesarean delivery was performed and the uterus was oversewn. Both mother and infant had satisfactory hospital courses. CONCLUSION: Meticulous closure of the myometrial bed following myomectomy is difficult via the laparoscope, and this could interfere with the integrity of the scar. If further studies confirm this experience, then laparoscopic myomectomy may need to be limited to patients who do not desire further childbearing.

Adult↗

Sequence of a cellulase gene from the rumen anaerobe Ruminococcus flavefaciens 17.

A cellulase gene (endA) was isolated from a library of Ruminococcus flavefaciens strain 17 DNA fragments inserted in pUC13. The endA product showed activity against acid-swollen cellulose, carboxymethyl-cellulose, lichenan, cellopentaose and cellotetraose, but showed no activity against cellotriose or binding to avicel. Nucleotide sequencing indicated an encoded product of 455 amino acids which showed significant sequence similarity (ranging from 56% to 61%) with three endoglucanases from Ruminococcus albus, and with Clostridium thermocellum endoglucanase E. Little relatedness was found with a cellodextrinase previously isolated from R. flavefaciens FD1.

Amino Acid Sequence↗

Reshaping a human monoclonal antibody to inhibit human respiratory syncytial virus infection in vivo.

We transferred the complementarity determining regions from a murine monoclonal antibody that neutralizes infection by respiratory syncytial virus (RSV) to a human IgG1 monoclonal antibody. The resulting reshaped human antibody lost affinity for RSV, but an additional alteration to one of the framework regions restored binding affinity and specificity. This second generation reshaped human monoclonal antibody cross-reacted with all clinical isolates of RSV tested and both prevented disease and cured mice even when administered four days after infection. We expect the antibody will prove useful in the management of this major childhood disease.

Amino Acid Sequence↗

Use of the end-to-end anastomosis stapling device in low colorectal anastomosis associated with radical gynecologic surgery.

Between 1978 and 1984, 49 rectosigmoid anastomoses were performed using the end to end anastomosis (EEA) stapler. Seventeen (35%) of the patients had prior radiation treatment. Twenty-eight (57%) of the anastomoses were at the level of the peritoneal reflection and 21 (43%) were at the level of the levators. Fourteen patients (29%) had diverting colostomies and 11 (79%) of these were closed. There were 5 complications (10%) directly related to the anastomosis. These included two strictures, two anastomotic breakdowns, and one case of fecal incontinence after colostomy closure. All complications arose in patients with prior radiation treatment.

Colon↗

Small group work therapy for the chronic mentally ill.

In 1980 the authors reviewed the records of the first 130 patients to enter small group work therapy, a program begun in 1964 by Arkansas State Hospital and Arkansas Rehabilitation Services in which chronic schizophrenic patients live in group homes and work in Hot Springs. Forty-five of the original patients were still in the program in 1980. Although the patients had been hospitalized for an average of 11 years, they spent an average of seven years in the program, during which time their hospital utilization dropped significantly. Forty-two were discharged to settings offering greater independence. The authors focus on the role of a rehabilitative unit of Arkansas State Hospital known as the HIP unit, which, until it was closed in 1976, prepared patients to live and work with each other before entering small group work therapy.

Adult↗

Prior cesarean section. A risk factor for adenomyosis?

Four hundred eighty-five cases of histologically proven adenomyosis were reviewed to determine if that condition might have been induced by transplanted endometrium at the time of cesarean section. The rate of cesarean section in the study group was 6.4%. Evidence of the cesarean scar was noted histologically in 13 of 31 patients (42%) who had undergone cesarean section, and 2 of the 13 (15%) had evidence of glands and stroma within the scar. Both patients had other pathology that could account for their symptoms. Prior cesarean section does not appear to be a risk factor for symptomatic adenomyosis.

Adult↗

Possible use of monoclonal antibodies to standardize the production and use of human urokinase.

Urokinase, a plasminogen activator found in urine is used in the treatment of pulmonary embolism, and is supplied commercially by several companies in Europe, U.S.A. and Japan. It exists in two forms, of molecular weights 50-55 000 and 33 000 daltons, which may differ in their therapeutic efficiency. A variety of assay systems exist to measure plasminogen activator activity--clot lysis, casein hydrolysis, amidolytic cleavage of synthetic peptide substrates. These assays are time-consuming, relatively insensitive, and cannot accurately assess the amount of the two molecular species in any preparation of urokinase. Standardization therefore presents a problem to manufacturers, control agencies, and clinicians. We have prepared a variety of monoclonal antibodies to human urokinase and have assessed their value as standardizing different commercial preparations of urokinase and measurement of urokinase for therapeutic monitoring.

Antibodies, Monoclonal↗