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PubMed1981

Elevated blood taurine levels in acute and evolving myocardial infarction.

Blood samples obtained from 97 consecutive patients admitted to the hospital for chest pain were analyzed for taurine concentrations. The mean value of the maximum taurine concentration in whole blood from AMI patients were greater than the mean value of the maximum taurine concentration in patients without AMI. There was no difference in plasma taurine levels between AMI and non-AMI patients, indicating that a cellular component(s) of whole blood was sequestering taurine. The increased blood taurine concentrations in the AMI patients evolved over the course of 70 hr and paralleled the increase in total CK levels. Blood taurine concentrations, in general, did not rise in patients who had chest pain of unknown etiology, skeletal muscle trauma, pleuritic pain, SVT/VT plus CV, acute pericarditis, acute cholecystitis, or angina pectoris. It is concluded that blood but not plasma taurine concentrations rise after acute myocardial injury and tend to be higher the more extensive the infarction. The mechanism of the blood taurine rise is unknown, but a myocardial source is probable. Also, there is evidence that the myocardium selectively leaks taurine, and not other amino acids. Monitoring blood taurine concentration in AMI may provide useful diagnostic and prognostic information.

Acute Disease↗
PubMed1980

Serial ultrasonography to assess evolving fetal macrosomia. Studies in 23 pregnant diabetic women.

Serial ultrasound estimates of fetal biparietal diameter and abdominal circumference were used as differential indices of intrauterine growth of insulin-insensitive and insulin-sensitive structures, respectively, in 23 White's classes A to C diabetic women. Biparietal diameter in all fetuses conformed to growth patterns for fetuses of nondiabetic mothers. However, two patterns were noted for abdominal circumference. Normal increases occurred in 13 fetuses; in the remaining ten, growth of abdominal circumference exceeded upper normal limits from weeks 28 to 32 of gestation onward. This latter group with putative "accelerated somatic growth" in utero had more immunoreactive insulin in amniotic fluid, weighed more at birth, and had more subcutaneous fat. Serial differential ultrasonography may be useful for detecting evolving macrosomia in diabetic pregnancies, and fetal insulin or insulin-like principles may contribute to the macrosomia.

Birth Weight↗
PubMed1993

The 33 kDa protein of the oxygen-evolving complex: a multi-gene family in tomato.

A cDNA was isolated by chance from tomato which had a high similarity to a cDNA clone from potato known to code for the 33 kDa protein of the oxygen-evolving complex [van Spanje et al. (1991) Plant Mol. Biol. 17: 157]. The sequence of a previously described partial cDNA clone from tomato [Ko et al. (1990) Plant Mol. Biol. 14: 217] which has also a high similarity but is not identical to the sequence described here indicates that tomato contains at least two genes coding for 33 kDa proteins per haploid genome. This conclusion is supported by Southern blot analysis. The tissue specific expression of the corresponding genes is described.

Amino Acid Sequence↗
PubMed1995

Translation elongation factor-3 (EF-3): an evolving eukaryotic ribosomal protein?

Fungi appear to be unique in their requirement for a third soluble translation elongation factor. This factor, designated elongation factor 3 (EF-3), exhibits ribosome-dependent ATPase and GTPase activities that are not intrinsic to the fungal ribosome but are nevertheless essential for translation elongation in vivo. The EF-3 polypeptide has been identified in a wide range of fungal species and the gene encoding EF-3 (YEF3) has been isolated from four fungal species (Saccharomyces cerevisiae, Candida albicans, Candida guillermondii, and Pneumocystis carinii). Computer-assisted analysis of the predicted S. cerevisiae EF-3 amino acid sequence was used to identify several potential functional domains; two ATP binding/catalytic domains conserved with equivalent domains in members of the ATP-Binding Cassette (ABC) family of proteins, an amino-terminal region showing significant similarity to the E. coli S5 ribosomal protein, and regions of predicted interaction with rRNA, tRNA, and mRNA. Furthermore, EF-3 was also found to display amino acid similarity to myosin proteins whose cellular function is to provide the motive force of muscle. The identification of these regions provides clues to both the evolution and function of EF-3. The predicted functional regions are conserved among all known fungal EF-3 proteins and a recently described homologue encoded by the Chlorella virus CVK2. We propose that EF-3 may play a role in the ribosomal optimization of the accuracy of fungal protein synthesis by altering the conformation and activity of a ribosomal "accuracy center," which is equivalent to the S4-S5-S12 ribosomal protein accuracy center domain of the E. coli ribosome. Furthermore, we suggest that EF-3 represents an evolving ribosomal protein with properties analogous to the intrinsic ATPase activities of higher eukaryotic ribosomes, which has wider implications for the evolutionary divergence of fungi from other eukaryotes.

ATP-Binding Cassette Transporters↗
PubMed1995

[Effect of the ketogenic diet for West syndrome into which early infantile epileptic encephalopathy with suppression-burst was evolved].

A male infant with early infantile epileptic encephalopathy (EIEE) was reported. Tonic spasms in series appeared since 1 month after birth and EEG showed a typical suppression-burst pattern. The patient was treated with a high-dose pyridoxal phosphate and thyrotropin-releasing hormone (TRH), but seizures were not controlled. ACTH was administered and the seizures disappeared transiently. The seizures reappeared during tapering ACTH and apparent cerebral shrinkage followed the ACTH therapy. Then, the patient who evolved into West syndrome was treated with ketogenic diet. The seizures disappeared immediately and EEG findings were improved. It is suggested that the ketogenic diet should be tried early for the treatment of EIEE.

Electroencephalography↗
PubMed1994

The evolving role of Hox genes in arthropods.

Comparisons between Hox genes in different arthropods suggest that the diversity of Antennapedia-class homeotic genes present in modern insects had already arisen before the divergence of insects and crustaceans, probably during the Cambrian. Hox gene duplications are therefore unlikely to have occurred concomitantly with trunk segment diversification in the lineage leading to insects. Available data suggest that domains of homeotic gene expression are also generally conserved among insects, but changes in Hox gene regulation may have played a significant role in segment diversification. Differences that have been documented alter specific aspects of Hox gene regulation within segments and correlate with alterations in segment morphology rather than overt homeotic transformations. The Drosophila Hox cluster contains several homeobox genes that are not homeotic genes--bicoid, fushi-tarazu and zen. the role of these genes during early development has been studied in some detail. It appears to be without parallel among the vertebrate Hox genes. No well conserved homologues of these genes have been found in other taxa, suggesting that they are evolving faster than the homeotic genes. Relatively divergent Antp-class genes isolated from other insects are probably homologues of fushi-tarazu, but these are almost unrecognisable outside of their homeodomains, and have accumulated approximately 10 times as many changes in their homeodomains as have homeotic genes in the same comparisons. They show conserved patterns of expression in the nervous system, but not during early development.

Animals↗
PubMed1995

Parameters of quality assurance: an evolving science.

The quality assurance field is rapidly evolving. The components of the quality assurance field, which include philosophy, assessment tools and methods, analysis and application of data, and research, are each growing in their conceptual validity and are also developing well defined relationships to each other. The philosophy underlying quality assurance has moved from a static concept of quality to conceptualising the quality of care as a dynamic state of health care. Quality assessment tools and methods are more valid and reliable, and research is emphasising outcomes of care and effectiveness studies, as well as methods of disseminating information to practitioners. This paper provides an overview of the quality assurance field, describing the changes that are taking place in each of its components and the relationships among them.

Humans↗
PubMed1994

The evolving role of angiotensin-converting enzyme inhibition in heart failure: expanding the protective envelope.

Congestive heart failure (CHF) continues to be a major cause of morbidity and mortality; in the United States alone, CHF afflicts 4 million patients, representing about 2% of the adult population; causes or contributes to more than 250,000 deaths yearly; and is the principal or secondary diagnosis in 6% of all hospital discharges. After the discovery of angiotensin-converting enzyme (ACE) inhibitors as potent antihypertensive agents, an increased understanding of the pathophysiology of CHF, in addition to the recognition of heart failure as a process that evolves through time, led to the use of these agents in patients with CHF. Subsequently, a series of multicenter trials systematically explored the role of ACE-inhibitor therapy in heart failure. The purpose of this review is to discuss some of these trials and to describe the answers that they provide to the following questions: Are vasodilators beneficial in the treatment of severe heart failure? Are ACE inhibitors beneficial in mild-to-moderate heart failure? Which vasodilator regimen (ACE inhibitors or hydralazine/isosorbide dinitrate) is more effective? Finally, are ACE inhibitors beneficial in asymptomatic patients at risk of heart failure?

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1995

Redefining nursing according to patients' and families' needs: an evolving concept. AACN Certification Corporation.

Patients' and families' needs have been displaced from the core of today's health-care system. Nurses are positioned to serve a pivotal role during such a critical time, as health-care systems evolve. The health-care system of the future must be driven by the needs of patients and families. Nurses must make decisions and take actions that are crucial in ensuring that this becomes a reality. Nurses must acknowledge that the historical conceptualization of nursing--delineating clinical practice dimensions according to a patient's diagnosis, a nurse's role, the clinical setting, and the patient's psychosocial and physiologic systems--is of limited value if we are to meet these future challenges. Redefining nursing practice according to patients' needs provides an organizing framework to examine, across all levels of nursing, the dimensions of practice most likely to meet patient needs and contribute to optimal outcomes, as well as enhance the linkages between practice, education, and research.

Clinical Competence↗
PubMedDate not supplied

MDR1 gene expression in myelodysplastic syndrome and in acute myeloid leukemia evolving from myelodysplastic syndrome.

The expression of the MDR1 gene, a multidrug resistance gene, was determined in patients (N = 24) with myelodysplastic syndrome or acute myeloid leukemia evolving from it. MDR1 RNA expression of the mononuclear cells was detected in 14 (58%) patients. Among patients who had progressed to acute myeloid leukemia (sAML) (N = 14), MDR1 RNA expression was seen in 8 (57%) patients. Expression was observed in the 2 patients who had been pretreated with MDR drugs. These findings indicate that the MDR1 gene is frequently expressed in MDS or sAML and suggest that multidrug resistance might be involved in the clinical drug resistance of these diseases.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1994

Collective adaptation in a statistical model of an evolving population.

We simulate asexually and sexually reproducing model populations evolving in a rugged fitness landscape where fit and unfit genotypes are distributed at random, and where all fit genotypes have the same a priori probability of reproduction. Varying the fraction chi of unfit genotypes at a fixed mutation rate we observe a strikingly different behavior for the two reproduction mechanisms. For the asexually reproducing population, the effective mutation rate lambda decreases roughly proportionally to (1-chi), and the fraction delta of sterile individuals--processing an unfit genotype--accordingly increases roughly proportionally to chi. On the other hand, lambda remains approximately constant (and delta increases proportionally to chi) for small values of chi:but, at a critical value chi*, both lambda and delta suddenly drop. This corresponds to the transition to an adaptive regime where the average fitness of the population is enhanced. We show how this transition can be interpreted in terms of an improvement of the collective fitness of the population.

Biological Evolution↗
PubMed1994

Plastocyanin and the 33-kDa subunit of the oxygen-evolving complex are transported into thylakoids with similar requirements as predicted from pathway specificity.

Plastocyanin and the 33-kDa subunit of the oxygen-evolving complex (OE33) are two of several thylakoid lumen-located proteins that are made in the cytosol, imported into chloroplasts, and subsequently transported into thylakoids. Recently, competition studies showed that there are two pathways for protein transport into the thylakoid lumen and that plastocyanin and OE33 are on the same pathway (Cline, K., Henry, R., Li, C., and Yuan, J. (1993) EMBO J. 12, 4105-4114). Our expectation is that transport requirements reflect the steps of the process and that proteins on the same pathway share similar requirements. Unfortunately, the transport requirements for plastocyanin and OE33 are not well established. Here, we investigated transport in a reconstituted system with isolated thylakoids. Efficient transport of OE33 and plastocyanin was only obtained when stromal extract was included in the assay. Heat or protease treatment of stromal extract eliminated its ability to stimulate transport. Transport was abolished by treatments designed to deplete ATP or to prevent its formation and was greatly reduced in the presence of ionophores that dissipate the trans-thylakoidal proton gradient. These results show that transport of OE33 and plastocyanin requires ATP and is stimulated by stromal protein(s) and the trans-thylakoidal proton gradient. Taken together, these and previous results suggest that there are two mechanistically distinct pathways for protein transport into the thylakoid lumen.

Adenosine Triphosphate↗
PubMed1994

Evolving trends revealed by autopsies of patients with the acquired immunodeficiency syndrome. 565 autopsies in adults with the acquired immunodeficiency syndrome, Los Angeles, Calif, 1982-1993 [corrected].

OBJECTIVE: To determine changes in causes of death, survival, and organ system distribution of major opportunistic infections and neoplasms in adults dying with the acquired immunodeficiency syndrome (AIDS) following the widespread use of antiretroviral therapy and prophylaxis for opportunistic infections since 1988. DESIGN: A retrospective review of autopsy records with gross and microscopic pathologic findings, laboratory data, and clinical histories in cases of AIDS, comparing findings from 1982 through 1988 with those from 1989 through May 1993. SETTING: All autopsies were performed on persons dying in the metropolitan Los Angeles, Calif, area from January 1982 through May 1993. RESULTS: In 565 adult cases of AIDS at autopsy, Pneumocystis carinii pneumonia (PCP) remained the most common cause of death, but both the frequency of and number of deaths of PCP declined over time. Deaths from bacterial sepsis, cytomegalovirus infection, Mycobacterium avium complex infection, and toxoplasmosis also declined during this period, but mortality from fungal infections, tuberculosis, encephalopathy, and causes unrelated to AIDS increased. The death rate from malignant lymphoma remained high. Kaposi's sarcoma (KS) continued to occur more frequently in patients whose risk factor for human immunodeficiency virus infection (HIV) was homosexuality or bisexuality, but the death rate from KS was greatest for patients with a risk factor of blood exposure to HIV. Survival was shorter and deaths from tuberculosis more common in patients with a history of intravenous drug use. Overall survival of patients in other AIDS risk groups increased over time, particularly in those treated with antiretroviral therapy. The organ system distribution of major opportunistic infections and neoplasms was similar throughout the years of the study. The lung was the most frequent organ involved by AIDS-associated diseases leading to death, followed by the gastrointestinal tract and the central nervous system. CONCLUSIONS: The causes of death in AIDS have evolved since 1988 following the widespread use of prophylactic and antiretroviral therapies in patients with HIV infection. This has occurred primarily from changes in overall frequency and death rates from infections. Organ system involvement by AIDS-associated diseases has not changed significantly over time.

AIDS Dementia Complex↗
PubMed1994

Evolving role of intensive and high-dependency care.

As stratified patient care evolves, and with an increasing population of elderly patients undergoing major surgery there is a growing demand for critical and high-dependency care beds. Results of an audit comparing the activity of a combined Intensive Care and High-Dependency Unit (ITU/HDU) in 1981 with 1991 has shown an increase in the number of patients admitted, particularly for high-dependency care. The overall mortality in 1981 was 12% compared with 9.5% in 1991. The greatest improvement was seen in ventilated patients, where the mortality was reduced from 54% in 1981 to 30% in 1991. An attempt is made to predict the demand for critical care and high-dependency beds for the future in a population of approximately 250,000 based on current trends. It is perceived that it will be necessary to establish a six-bed ITU and eight high-dependency surgical beds in two separate but adjacent units, where there will be a free interchange of skills at the different levels of care.

Adolescent↗
PubMed1993

Evolving toward effective therapy for acute ischemic stroke.

Acute ischemic stroke is a common, devastating disorder without beneficial therapy. Recent advances concerning the pathophysiology of ischemic brain injury have led to the development of rational pharmacological interventions. Thrombolytic and cytoprotective therapies may be useful and are being evaluated in clinical trials. The design of adequate clinical trials to evaluate these promising therapies has also evolved based on experience. Potential therapy for acute ischemic stroke must be assessed in a large number of patients who are given the intervention within hours of onset using a neurological scoring scale and a disability scale. Several new magnetic resonance imaging technologies are emerging that should allow the clinician to rapidly and accurately identify ischemic brain lesions and to evaluate cerebral perfusion. The availability of potentially efficacious therapies for ischemic stroke evaluated in well-designed clinical trials with magnetic resonance imaging technology, which can also assess therapeutic effects in vivo, should lead to the emergence of therapy to improve the outcome of patients with ischemic stroke in the near future.

Acute Disease↗
PubMed1993

Emergency myocardial revascularization for myocardial infarction evolving outside the hospital. A feasible option when thrombolysis and coronary angioplasty have failed.

Most reports on emergency coronary revascularization deal with failed percutaneous transluminal coronary angioplasty (PTCA) or refractory ischemia which developed after hospital admission. The objective of this study was to evaluate the feasibility and prognosis of emergency revascularization for acute myocardial infarction evolving outside the hospital. Between 1974 and 1992 54 cases were included in this study. The patients had both electrocardiographic and clinical evidence of ongoing ischemia. One or more infarct-related obstructed coronary arteries were documented by emergency angiography. Since 1981, the patients have been given urokinase, and, since 1986, they have undergone PTCA initially and, when reperfusion failed, revascularization was started. Overall in-hospital mortality has been 11.1% (6/54). All other patients were discharged in satisfactory condition. Follow-up for periods of up to nearly twenty years has been uneventful with the exception of two late sudden deaths. The above results confirm that emergency coronary revascularization is a therapeutical option worth considering.

Adult↗
PubMed1993

Rheumatoid arthritis, relapsing polychondritis, and pyoderma gangrenosum evolving into non-Hodgkin's lymphoma.

In human beings, the function of the immune system and of inflammation is to protect the individual against invading organisms such as bacteria, viruses, parasites, and fungi as well as thermal and mechanical injuries. The inflammatory process, initiated to destroy foreign organisms or an inappropriate immune response/target tissue, may lead to injury, the destruction of host tissue, and the development of the disease process. This article describes the history of a patient with four disorders of unknown cause, all of which may have evolved from one immunologic aberration.

Arthritis, Rheumatoid↗
PubMed1996

Evolving concepts in the diagnosis and treatment of arterial high flow priapism.

PURPOSE: We investigated 2 evolving concepts in the management of arterial priapism: 1) the efficacy of perineal duplex Doppler ultrasound as a diagnostic alternative to arteriography and 2) the therapeutic alternative of expectant management. MATERIALS AND METHODS: We evaluated 10 patients with high flow arterial priapism. RESULTS: Compared to selective internal pudendal arteriography, perineal duplex Doppler ultrasonography was associated with 100% sensitivity and 73% specificity rates. Compared to physical examination, followup duplex ultrasonography had a sensitivity of 75% and specificity of 100%. Followup penile duplex ultrasound demonstrated restoration of antegrade flow in the cavernous artery after embolization. Patients on expectant management remained potent as long as 31 years. CONCLUSIONS: Diagnostic perineal duplex Doppler ultrasonography and expectant management are valuable tools for the treatment of arterial priapism. A new algorithm for patient care is presented.

Adolescent↗