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PubMed2005

Sequence-based discovery of the human and rodent peroxisomal proteome.

BACKGROUND: Peroxisomes are metabolic organelles present in virtually all eukaryotic cells. They contain enzymes involved in hydrogen peroxide-based respiration and lipid metabolism. At present, only a small number of peroxisomal enzymes that are associated with oxidative stress response and metabolic disorders have been characterised biochemically. Therefore, we devised a sequence-based, multistep knowledge discovery strategy to identify potential novel peroxisomal protein candidates in small rodent model organisms and human. METHODS: Screening of 130,629 putative translations of GenBank rodent and primate mRNA sequences was limited to the classical type-1 peroxisomal targeting signal [SA]-K-L. This motif is over-represented among peroxisomal proteins and has a high targeting efficiency. Subsequent steps of identifying co-occurring motifs, secondary structure properties, orthologues and variants, in combination with literature searching and visual inspection by domain experts, aimed at reduction of both false positive and negative validation targets. RESULTS: Our method yielded 117 known peroxisome-targeted proteins and 29 novel candidate proteins. Of special interest were the mouse C530046K17Rik and 1300019N10Rik protein sequences that contain domains associated with enzymatic functions. C530046K17Rik showed no similarity to any known sequence of the animal kingdom, but weak similarity to the possible Leishmania quinone oxidoreductase and a putative cyanobacterium nicotinamide adenine dinucleotide phosphate (NADP)-dependent oxidoreductase. 1300019N10Rik contains two protease-related domains, glutamyl endopeptidase I and trypsin-like serine and cysteine proteases, which may have unique specificities to achieve efficient breakdown of proteins in the peroxisomes. CONCLUSION: One mouse C57BL/6J strain-specific isocitrate dehydrogenase 1 isoform might be suitable to investigate potential phenotypes associated with the deficit of the intraperoxisomal reduced form of NADP (NADPH) and 2-oxoglutarate. Our biological knowledge discovery strategy enabled not only the identification of peroxisomal enzymes already described in the literature, but also the prediction of several novel proteins with possible roles in peroxisomal biochemistry and metabolism that are currently under experimental validation.

Amino Acid Sequence↗
PubMed2002

[Improvement of osseointegration of bio-inert ceramics by modification of the surface--results of an animal experiment].

The aim of this experimental study was to screen different surface structures of alumina and zirconia ceramic implants for their osteointegration properties. Alumina and zirconia ceramic test implants having different surface structures (smooth, macro-structured, corundum-blasted, porous) were implanted in the femora of mini-pigs, and left in situ for 12 weeks. After removal, the implants were evaluated macroradiographically and histologically. The smooth and macro-structured ceramic surfaces showed virtually no bony ingrowth, neither in the cortical nor the cancellous bone areas. In contrast, a rough surface finish or a porous surface structure allowed extensive bony ingrowth. The osteointegration rates varied between 20.5% and 41.7% (cancellous bone), and between 26.0% and 52.8% (cortical bone). With regard to the development of ceramic implants for clinical use, for example in the field of total hip replacement, these data provide a basis for further, more comprehensive studies.

Aluminum Oxide↗
PubMed1991

Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey.

A detailed ocular examination, including perimetry, was conducted on 5308 black and white subjects aged 40 years and older in a population-based prevalence survey in east Baltimore, Md. Repeated, detailed examinations were carried out on selected subjects. Roughly half of all subjects with optic nerve damage from primary open angle glaucoma, regardless of race, were unaware that they had the condition. The average intraocular pressure (IOP) among black patients with glaucoma who were receiving treatment was virtually identical to that in those black patients who were not receiving treatment (median IOP, 20 mm Hg); treated eyes of white patients had a lower IOP than those eyes of white patients who were not receiving treatment (mean [+/- SD] IOP, 18.69 +/- 3.23 mm Hg vs 24.15 +/- 5.23 mm Hg; P less than .001). The risk of glaucomatous optic nerve damage increased with the height of the screening IOP, particularly at levels of 22 to 29 and 30 mm Hg and above (relative rate compared with IOP of 15 mm Hg or lower, 12.8 and 40.1 mm Hg, respectively). More than half of all glaucomatous eyes had a screening IOP below 21 mm Hg, whether these eyes were receiving treatment or not. The IOP in glaucomatous eyes tended to rise on follow-up, in contrast with nonglaucomatous eyes in which the IOP was as likely to rise as to fall. Results confirmed that IOP is an important factor in glaucoma, but did not support the traditional distinction between "normal" and "elevated" pressure, nor its corollaries, "low-tension" glaucoma and "high-tension" glaucoma.

Black People↗
PubMed2004

Regulatory immunotoxicology: does the published evidence support mandatory nonclinical immune function screening in drug development?

Recent immunotoxicity guidance documents from the EU CHMP and the US FDA apply significantly different weightings to immune function testing; whereas the former mandates (as a starting point) incorporation of immune function tests (IFTs) to screen for immunotoxic potential in sub-chronic rodent toxicity studies, the more cautious 'for cause' FDA approach recommends the use of IFTs only when warranted by evidence obtained from conventional nonclinical and/or clinical studies. Conclusions from detailed evaluations of several key drugs, including salmeterol and some opioids, challenge the notion that data on these examples support the need for IFTs to detect unintended immunosuppression. Given the virtual absence of convincing pharmaceutical examples and the rarity of unintended immunosuppression, routine immune function testing of all new pharmaceuticals is not considered justified. Resources currently being employed in this manner in an attempt to detect a seemingly rare phenomenon would appear to be better applied to the development of reliable predictive assays for drug hypersensitivity, which is known to cause significant patient morbidity. Any moves towards a globally harmonised guideline that recommends the use of concern-based IFTs, need ideally to be accompanied by the establishment of appropriate historical control reference intervals and interpretation criteria to support a reliable weight-of-evidence approach to data evaluation.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1999

Surgical aspects of hyperinsulinemic hypoglycemia.

To make a diagnosis of insulinoma, one must consider it. Neuroglycopenic symptoms are the most prominent and convincing, and the combination of hypoglycemia and endogenous hyperinsulinemia are diagnostic of insulinoma. A glucose level of approximately 40 mg/dL with a concomitant insulin level of 6 microU/mL, a C-peptide level exceeding 200 pmol/L, and a negative screening for sulfonylurea must be documented to confirm the diagnosis. Although in the author's experience, preoperative ultrasound is the best and often the only test performed in the patient undergoing a first-time operation, arteriography is perhaps the single most effective localization test performed on a nationwide basis. Expertly performed intraoperative ultrasonography assists in tumor localization and in delineating important related anatomy and has become virtually routine in the author's surgical practice. Insulinomas are typically benign, single, and small, and are generally firmer than surrounding normal pancreas. Extensive surgical exposure may be required to identify and safely remove the tumor. Enucleation is preferred by the author, but distal pancreatectomy for tumors in the body or tail is an excellent method as well. Tumors in the head of the pancreas are usually enucleated, and pancreatoduodenectomy is rarely performed. The most troublesome complication is a pancreatic leakage causing pseudocyst, abscess, or fistula. Except in MEN 1 syndrome, in which a more extensive resection is usually indicated, excision of a single benign insulinoma leads to long-term cure of the disease. The successful excision of an insulinoma will profoundly affect a patient's life.

Angiography↗
PubMed1996

Office Microlaparoscopy Under Local Anesthesia

We assessed the utility, tolerance, and costs associated with office microlaparoscopy under local anesthesia using fiberoptic microlaparoscopes (<2 mm) and accessory instrumentation (<2 mm) for 100 of the following procedures: diagnostic laparoscopy to evaluate infertility including chromopertubation; diagnostic laparoscopy for chronic pelvic pain (CPP), including biopsy of endometriosis and conscious pain mapping; and early second-look laparoscopy including lysis of adhesions. A prospective nonselected cohort study was conducted on all women with CPP or infertility who consented to office microlaparoscopy under local anesthesia. A questionnaire was developed to follow all aspects of patient acceptance and tolerance of the procedures, and women were screened preoperatively, and 30 minutes and 1 week postoperatively. Pain was evaluated with modification of the McGill pain inventory relative intensity scale. A subset of questions evaluated the recovery period, and time and length of all aspects of the procedure and recovery were recorded. Second-look procedures were significantly more painful than diagnostic ones, and women with CPP experienced significantly greater pain than those with infertility. Virtually all expressed high satisfaction with the procedure. There were no complications, and no procedures required general anesthesia. Compared with traditional laparoscopy, there was a reduction in costs greater than 70%.

Journal Article↗
PubMed2006

A twin study of lifetime Generalized Anxiety Disorder (GAD) in older adults: genetic and environmental influences shared by neuroticism and GAD.

The nature of Generalized Anxiety Disorder (GAD) and worry across the lifespan remains incompletely understood. We investigated genetic and environmental influences on GAD and the proportion of genetic and environmental variation in GAD that is shared with neuroticism in older adult twins. Participants included 1618 monozygotic and 2291 same-sexed dizygotic twin pairs from the Swedish Twin Registry aged 55 to 74. Participants provided personality information in 1973 and also participated in a telephone screening between 1998 and 2002 that included an assessment for lifetime GAD. Univariate biometric models indicated that both GAD and neuroticism were moderately heritable (.27 and .47, respectively), while the balance of variation reflected environmental factors unique to the individual. Bivariate analyses indicated that approximately one third of the genetic influences on GAD were in common with genetic influences on neuroticism, while individual specific environmental influences were virtually unshared between GAD and neuroticism. Analyses of sex effects suggested that men and women differed in the frequency of lifetime GAD and level of neuroticism; however, no sex differences for genetic and environmental influences for either trait were identified.

Anxiety Disorders↗
PubMed1986

High-contrast mammography with a moving grid: assessment of clinical utility.

Mammography techniques using moving grids produce superior breast images in many patients but result in increased radiation dose. This prospective controlled study of 1000 unselected screen-film mammography patients identifies a subset of women who are most likely to benefit from higher-dose grid-assisted techniques. In approximately 60% of the patients, the increased contrast of grid films produced a noticeable improvement in overall image quality. In only 20% of cases did this translate into clinically useful information, however, usually resulting in an increased level of confidence in interpretation. In virtually all the cases in which grid images aided mammographic diagnosis, the patients were women having more than 50% dense fibroglandular tissue or compressed breast thickness greater than 6 cm (only 37% of the study population). We suggest that the use of grid techniques be restricted to patients with such dense or thick breasts, because only in these women can the increase in radiation dose be justified.

Breast Neoplasms↗
PubMed2002

Highly focused clonal composition of CD8(+) CD28(neg) T cells in aqueous humor of fuchs heterochromic cyclitis.

Fuchs heterochromic cyclitis (FHC) is characterized by a predominant CD8(+) T cell subset infiltrating the anterior chamber, but the clonal composition of these T cells is unknown. In the present study, T cell repertoire diversity of the accumulating T cells was analyzed to investigate if a high degree of restriction could indicate antigen-driven immune response. Aqueous humor (AH) and peripheral blood cells were collected in two patients with FHC. T cell repertoire diversity was screened by T cell receptor (TCR) BV family expression. In one patient, several BV gene segments were used by lymphocytes from the AH but with over-representation of BV16 that accounted for around half of the expressed intraocular repertoire. In the other patient, a more restricted TCRBV usage was found in AH, as only BV15 and BV18 were expressed in the ocular sample. In this patient, virtually all AH CD8(-) T-cells were CD28- and CD57-negative by three-color flow cytometry, an immunophenotype suggestive of past antigenic stimulation. High resolution immunoscope analysis of TCRBV CDR3 profiles and sequencing of subcloned TCRBV-BJ PCR products evidenced a highly restricted TCRBV-BJ usage, since virtually all the intraocular cells comprise only five clonotypes in this patient. Unique peaks of CDR3 length were found in BV15 joined to BJ2S1, BJ2S3 and especially BJ2S5, in AH but did not predominate in blood. Conversely, identical clonotypes using rearranged BV18 and BJ2S7 gene segments were detected in both AH and peripheral blood. Maintenance of the TCRBV18-BJ2S7 clonotypes in aqueous humor was demonstrated over 6 months in this patient, with a switch in the predominance of two clonotypes. Our results show the presence of a finite number of CD8(+)CD28(neg) T cell clonotypes, which suggests an antigen-driven process and the involvement of these T cells in the pathogenesis of FHC.

Aqueous Humor↗
PubMed2005

Managed care for AIDS patients: is bigger better?

CONTEXT: Medicaid provides funds for the majority of AIDS-related health care services in the United States. In an effort to stabilize steeply rising Medicaid costs, managed care programs are replacing traditional fee-for-service Medicaid services. OBJECTIVE: To assess the impact of patient volume on the quality of care received by AIDS patients within a state's Medicaid managed care system. DESIGN: Cohort study of AIDS patients who were enrolled in Medicaid at any time from July 1997 through December 1998. Patient charts were reviewed and abstracted. Additional information on the AIDS patients' mode of exposure, date of AIDS diagnosis, and vital status were obtained from the state's HIV/AIDS surveillance database. PATIENTS AND SETTING: All known AIDS patients enrolled in the Maryland Medicaid managed care program were eligible. A total of 1052 of 1585 patient records were reviewed and analyzed. MAIN OUTCOME MEASURES: CD4 and viral load tests; preventive health care including screening for sexually transmitted infections; placement of tuberculin purified protein derivative (PPDs); hepatitis B and C screening; vaccination for hepatitis B; vaccination for pneumococcal pneumonia; Papanicolaou test screening; medication utilization including receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia; case management services; and mortality. RESULTS: Health care quality indicators were examined by comparing the performance of clinical sites that saw a low volume of Medicaid AIDS patients per site (1-15 patients), a medium volume (16-100 patients), and a high volume (101-500 patients). High-volume sites performed better on virtually all quality indicators. There were few differences in performance between low- and medium-volume sites. High-volume sites experienced a greater number of patient deaths; this was true after adjusting for potential confounders such as age, use of antiretrovirals, time since AIDS diagnosis, appropriate laboratory monitoring, and hospitalizations. CONCLUSIONS: Variations in quality of care for AIDS patients were observed in a statewide managed care system. These variations existed despite provisions to ensure quality care such as an enhanced payment system for managed care organizations providing services for AIDS. High-volume sites were more likely to adhere to Public Health Service guidelines and may offer the best opportunity to provide high-quality AIDS care.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Primary structure of the rat kidney band 3 anion exchange protein deduced from a cDNA.

A rat kidney cDNA library was screened using an oligonucleotide hybridization probe derived from an amino acid sequence of the mouse erythrocyte Band 3 Cl-/HCO3- exchanger. Ten cDNAs representing a single class of mRNA and encoding the kidney Band 3 anion exchanger were isolated. Analysis of the deduced amino acid sequence revealed that kidney Band 3 is a truncated version of erythrocyte Band 3. The 848-amino acid rat kidney protein is virtually identical to mouse erythrocyte Band 3 except that it lacks the first 79 amino acids of the N-terminal cytoplasmic domain. Exons 1, 2, and 3 of the Band 3 gene, which are included in erythrocyte Band 3 mRNA, are not present in the kidney cDNA. The 5'-untranslated regions of kidney Band 3 transcripts contain sequences from the third intron and exons 4 and 5 of the Band 3 gene. The sequences from exons 4 and 5 that serve as untranslated sequences in the rat kidney mRNA have the potential to encode amino acids 46-79 of erythrocyte Band 3 but are not part of an open reading frame; the apparent translation initiation site corresponds to codon 80 of mouse erythrocyte Band 3 mRNA. Northern blot hybridization studies indicate that two additional Band 3 mRNAs, which differ in size from the major 4.5-kilobase pair transcript in kidney, are expressed at low levels in kidney and brain.

Amino Acid Sequence↗
PubMedDate not supplied

Neonatal hyperbilirubinemia.

Evidence of bilirubin-related brain damage has been reported in infants with kernicterus discharged as healthy from well-baby nurseries. Lapses in care have been attributed as root causes for kernicterus in an era when there should be no barriers to safe and effective bilirubin reduction strategies. Between 1984 and 2002, at least 125 cases of kernicterus occurred in the United States. This may be an underestimate because kernicterus is not a reportable condition in this country. In almost all cases, kernicterus is a preventable condition. The updated 2004 American Academy of Pediatrics guidelines recommend a systems approach, which, if implemented by all birthing institutions, should prevent virtually all cases of kernicterus in term and near-term infants.

Disease Notification↗
PubMed1996

Client views on periodic health examinations: opinions and personal experience.

Clients' views on periodic health examinations (PHEs) were examined in a questionnaire study in Tampere, Finland. A sample of 240 clients aged 45 years looked back at their recent experiences of PHE screening and counselling sessions with a public health nurse. According to the clients' accounts, the discussions and counselling had dealt with living habits and, to a lesser extent, diseases, symptoms and the prevention of illness. The vast majority of the respondents appreciated the friendly and considerate manner in which the nurse dealt with the situation. About half of them felt that the discussion was personally important to them. Virtually all respondents saw the PHE programme as beneficial for everyone. Opinions were more divided on the benefits of the health examination sessions compared with medical help from a physician or with laboratory tests. The dimensions of client opinions were extracted by means of factor analysis. One of the factors emerging in the analysis demanded access to health examinations from the vantage point of individual rights or entitlement. In women, a factor emphasizing self-care was also discerned. The interpretation of the factors was based on the social tradition of community-based health services in Finland by means of the concept of social representation.

Attitude to Health↗
PubMed2006

Gestalt operating room display design for perioperative team situation awareness.

The perioperative environment is a complex, high risk environment that requires real-time coordination by all perioperative team members and accurate, up-to-date information for situation assessment and decision-making. There is the need for a "Gestalt" holistic awareness of the perioperative environment to enable synthesis and contextualization of the salient information such as: patient information, case and procedure information, staff information, operative site view, physiological data, resource availability. One potential approach is to augment the medical toolkit with a large screen wall display that integrates and makes accessible information that currently resides in different data systems and care providers. The objectives are to promote safe workflows, team coordination and communication, and to enable diagnosis, anticipation of events, and information flow from upstream to downstream care providers. We used the human factors engineering design process to design and develop a display that provides a common operational picture for shared virtual perioperative team situation awareness to enhance patient safety.

Awareness↗
PubMed1987

Detection of androgenic anabolic steroids in urine.

Virtually all professional and amateur sporting organizations forbid the use of androgenic anabolic steroids (AAS). The International Olympic Committee, United States Olympic Committee, and more recently the National Collegiate Athletic Association enforce the regulations by conducting urine testing. Over the past 3 years we have conducted about 8000 tests for AAS in urine and discovered several hundred positive cases. AAS when present in urine can be detected by screening and confirmatory tests using gas chromatography-mass spectrometry.

Anabolic Agents↗
PubMed1980

[Bacteriological evaluation of surgical masks (author's transl)].

An experimental set-up is described permitting the evaluation and quantification under controlled conditions of retention efficiencies of surgical mask materials and different types of masks, using bacterial aerosols standardized both quantitatively and qualitatively. Screening of various materials used in one-way surgical paper masks has shown that, apart from the one-layered thin models, present paper masks with bacterial transmittance under 1% are far superior to the muslin masks of the past. For meeting the aseptical requirements in hospital operating rooms, adaptable masks (green exterior) provided with multi-layered polyester filter pads have proven most suitable by their virtual impenetrability for bacteria. After several hours use and heavy wetting of the filters layers, no increase of bacterial transmittance was observed.

Bacteria↗
PubMed2003

Subtyping of foodborne and environmental isolates of Escherichia coli by multiplex-PCR, rep-PCR, PFGE, ribotyping and AFLP.

A total of 54 isolates were characterized by multiplex-PCR for toxin genes and genotyped using several DNA fingerprinting methods: using repetitive extragenic palindromes (REP) and Box primers (rep-PCR), amplified fragment length polymorphism (AFLP), pulsed-field gel electrophoresis (PFGE) and ribotyping. The known-pathogenic strains tested were from food and clinical samples (34 strains) and included serovars O157:H7, O111:H8, O111:H11, O91:H21 and O55:H7. Two type cultures, Escherichia coli K12 (ATCC 29425) and DUP-101 (ATCC 51739), were included as known non-pathogenic strains and an additional 17 previously unclassified isolates from animal fecal samples. Comparisons of genomic DNA fingerprint patterns using unweighted pair group method with arithmetic averages (UPGMA) cluster analysis of Jaccard similarity indices indicated that all methods tested showed a greater similarity between the E. coli O157:H7 strains than to other isolates. On the basis of these studies, we propose that AFLP, REP-PCR, Box-PCR and ribotyping techniques can all be used for discriminating O157:H7 isolates and are preferred for large-scale screening because of the speed and ease of the methods. The PFGE method is the best to discriminate between subtypes of O157:H7 associated with specific outbreak investigations; however, it is more time consuming and unnecessary if subtyping is not required. There are differences between the dendrograms generated from each method and the relationship between the other strains analyzed. However, the fingerprint profiles of the O157:H7 isolates were virtually identical using REP-PCR and Box-PCR enabling easy distinction of the group. Thus, these typing methods have the potential to aid investigators in identifying the source of an outbreak to prevent or control further spread of E. coli O157:H7.

Bacterial Toxins↗
PubMed2001

Hybrid 3D visualization of the chest and virtual endoscopy of the tracheobronchial system: possibilities and limitations of clinical application.

OBJECTIVE: A hybrid rendering method which combines a color-coded surface rendering method and a volume rendering method is described, which enables virtual endoscopic examinations using different representation models. MATERIALS AND METHODS: 14 patients with malignancies of the lung and mediastinum (n=11) and lung transplantation (n=3) underwent thin-section spiral computed tomography. The tracheobronchial system and anatomical and pathological features of the chest were segmented using an interactive threshold interval volume-growing segmentation algorithm and visualized with a color-coded surface rendering method. The structures of interest were then superimposed on a volume rendering of the other thoracic structures. For the virtual endoscopy of the tracheobronchial system, a shaded-surface model without color coding, a transparent color-coded shaded-surface model and a triangle-surface model were tested and compared. RESULTS: The hybrid rendering technique exploit the advantages of both rendering methods, provides an excellent overview of the tracheobronchial system and allows a clear depiction of the complex spatial relationships of anatomical and pathological features. Virtual bronchoscopy with a transparent color-coded shaded-surface model allows both a simultaneous visualization of an airway, an airway lesion and mediastinal structures and a quantitative assessment of the spatial relationship between these structures, thus improving confidence in the diagnosis of endotracheal and endobronchial diseases. CONCLUSIONS: Hybrid rendering and virtual endoscopy obviate the need for time consuming detailed analysis and presentation of axial source images. Virtual bronchoscopy with a transparent color-coded shaded-surface model offers a practical alternative to fiberoptic bronchoscopy and is particularly promising for patients in whom fiberoptic bronchoscopy is not feasible, contraindicated or refused. Furthermore, it can be used as a complementary procedure to fiberoptic bronchoscopy in evaluating airway stenosis and guiding bronchoscopic biopsy, surgical intervention and palliative therapy and is likely to be increasingly accepted as a screening method for people with suspected endobronchial malignancy and as control examination in the aftercare of patients with malignant diseases.

Adult↗

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