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Biomedical subjects

B C Levin

Publications and source records attributed to B C Levin.

At least 19 recordsLinked to original sources

A review of the DNA standard reference materials developed by the National Institute of Standards and Technology.

The Standard Reference Materials Program at the US National Institute of Standards and Technology (NIST) has three human DNA standard reference materials (SRM 2390, SRM 2391a, and SRM 2392) currently available [1, 2]. Both the DNA profiling SRM 2390 and the polymerase chain reaction (PCR)-based DNA profiling SRM 2391a are intended for use in forensic and paternity identifications, for instructional law enforcement, or for non-clinical research purposes and are not intended for clinical diagnostics. The mitochondrial DNA (mtDNA) SRM 2392 is to provide standardization and quality control when performing PCR and sequencing any segment or the entire 16,569 base pairs that comprise human mitochondrial DNA. SRM 2392 is designed for use by the forensic, medical, and toxicological communities for human identification, disease diagnosis or mutation detection.

DNA↗

A human mitochondrial DNA standard reference material for quality control in forensic identification, medical diagnosis, and mutation detection.

A human mitochondrial DNA (mtDNA) standard reference material (SRM 2392) will provide quality control when mtDNA is sequenced for forensic identifications, medical diagnosis, or mutation detection. SRM 2392 includes DNA from two lymphoblast cell cultures (CHR and 9947A) and cloned DNA from the CHR HV1 region, which contains a C stretch and is difficult to sequence. The mtDNA sequence (but not the DNA) of a third human template GM03798 is provided for comparison. Fifty-eight unique primer sets allow any area or the entire mtDNA (16,569 bp) to be amplified and sequenced. While none of the differences in these three templates correspond to published mutations associated with specific diseases, some of these differences did result in animo acid changes compared with that published by S. Anderson et al. (1981, Nature 290: 457-465). An interlaboratory evaluation of the amplification, sequencing, and data analysis of the CHR template was conducted by four laboratories. Corroboration of the SRM results will provide quality assurance that any unknown mtDNA is also being amplified and sequenced correctly.

Cell Line↗

Secondary intention healing of exposed scalp and forehead bone after Mohs surgery.

For Mohs surgical wounds that show exposed bone (ie, bone denuded of periosteum), healing by secondary intention may be preferable to surgical reconstruction. To determine the appropriateness of secondary intention healing, we reviewed surgical outcome in 205 patients with Mohs wounds of the scalp and forehead that had healed by secondary intention. Of these patients, 38 had Mohs wounds showing exposed bone. The mean area of exposed bone was 1074 mm(2); the mean area of exposed soft tissue was 1575 mm(2). The mean time for wounds with intact periosteum to epithelialize was 7 weeks; the mean time for bare bone to epithelialize was 13 weeks. All wounds healed without infection or tissue breakdown. We conclude that secondary intention healing of scalp and forehead wounds showing exposed bone is a safe and effective method of wound management after Mohs surgery.

Elasticity↗

Forensic applications of mitochondrial DNA.

Human mitochondrial DNA has become a useful tool in forensic investigations. Its polymorphic nature and maternal inheritance are characteristics that have, combined with its sequence information, enabled investigators to identify missing persons, war casualties and individuals involved in mass disasters and criminal cases. Various screening procedures have been developed to reduce the need to sequence samples that do not match, but DNA-sequence information is still necessary to verify a match. Even though several challenges remain before mitochondrial-DNA-sequence information can be used unambiguously, comparative mitochondrial-DNA-sequence analysis appears to be a reliable and powerful means for human identification.

DNA, Mitochondrial↗

Spontaneous healing of Mohs wounds of the cheek: a cosmetic assessment.

BACKGROUND: Facial defects after Mohs surgery may be closed at the time of surgery, shortly thereafter, or allowed to heal spontaneously. Selection of appropriate management options requires accurate prediction of the final cosmetic result. OBJECTIVE: To determine the relative merits of treatment options for facial defects resulting from Mohs surgery. METHODS: We prospectively and retrospectively analyzed outcomes for 132 wounds of the cheek resulting from Mohs surgery and allowed to heal spontaneously. The cheek was delineated into topographic areas and the wound location, size, and depth were recorded. Patients were observed intermittently, and a final evaluation of cosmesis was made after > or = 6 months. RESULTS: Most wounds in the nasolabial fold and preauricular areas healed with excellent results and half the wounds in the medial area of the cheek healed with good or excellent results. Central and mandibular areas of the cheek healed unpredictably, and results were unsatisfactory for most of these wounds. CONCLUSION: Final cosmetic results of Mohs surgery in the cheek area can be predicted on the basis of location, size, and depth of the wound, enabling physicians to knowledgeably select the most suitable treatment option.

Adult↗

Mohs wounds of the forehead: healing by secondary intention.

Accurate prediction of the course of wound healing allows patients with Mohs surgical wounds on the face to be objectively selected either for surgical repair or for spontaneous healing. Parameters affecting wound healing--location, depth and size of wound--were documented at intervals for 135 patients who had full-thickness defects in the forehead after Mohs surgery, which were left to heal by secondary intention. Quality of cosmesis was determined at least four months after surgery. Final cosmetic result was predictable on the basis of wound location, size and depth. Allowing selected Mohs surgical wounds to heal spontaneously offers optimal cancer surveillance, simplified wound care and elimination of reconstructive procedures along with their associated costs and potential complications.

Adolescent↗

New approaches to toxicity: a seven-gas predictive model and toxicant suppressants.

Two new research approaches in combustion toxicology are: 1. the prediction of smoke toxicity from mathematical equations, which are empirically derived from, experiments on the toxicological interactions of complex fire gas mixtures and 2. the use of toxicant suppressants in materials or products to prevent the formation of toxic combustion products. The predictive approach consists of burning materials using a bench-scale method that simulates realistic fire conditions, measuring the concentrations of the primary fire gases--CO, CO2, low O2, HCN, HCl, HBr, and NO2--and predicting the toxicity of the smoke using either the 6- or 7-gas N-Gas Model. These models are based on the results of toxicological studies of these primary gases as individual gases and as complex mixtures. The predicted toxic potency is checked with a small number of animal (Fischer 344 male rats) tests to assure that an unanticipated toxic gas is not generated or an unexpected synergistic or antagonistic effect has not occurred. The results indicate if the smoke from a material or product is extremely toxic (based on mass consumed at the predicted toxic level) or unusually toxic (based on the gases deemed responsible). The predictions based on bench-scale laboratory tests have been validated with full-scale room burns of a limited number of materials of widely differing characteristics chosen to challenge the system. The advantages of this new approach are 1. the number of test animals is minimized by predicting the toxic potency from the chemical analysis of the smoke, 2. smoke may be produced under conditions that simulate the fire scenario of concern, 3. fewer tests are needed, thereby reducing the overall cost of the testing and 4, information is obtained on both the toxic potency of the smoke and the responsible gases. The N-Gas Models have been developed into the N-Gas Method (described in this paper) and these results have been used in computations of fire hazard. The 6-Gas Model is now part of the international standard ISO 13344 approved by 16 member countries of the International Standards Organization (ISO) and is also included in the U.S. national standard ASTM E1678 approved by the American Society for Testing and Materials (ASTM). In addition, the 6-Gas Model is used in the American National Standard--NFPA 269--approved by the National Fire Protection Association (Quincy, MA). The second new research approach, toxicant suppressants, examines the potential of chemical compounds, which when added to a material, to inhibit or reduce the concentration of a specific toxic gas normally generated during the material's thermal decomposition. The effectiveness of this approach was demonstrated at the National Institute of Standards and Technology (NIST) when HCN generation was reduced by 90% and the resultant toxicity of the combustion products was lowered by 50% when a flexible polyurethane foam (FPU) was treated with 0.1% (by weight) cuprous oxide (Cu2O). Copper and cupric oxide (CuO) also reduced the HCN generation but were not as efficient as Cu2O. Although melamine-treated FPU foams are being promoted as more fire safe than standard foams, a melamine-treated foam generated 10 times more HCN than a foam without melamine. The addition of Cu2O to this melamine foam also reduced the HCN generation by 90%.

Animal Testing Alternatives↗

New research avenues in toxicology: 7-gas N-Gas Model, toxicant suppressants, and genetic toxicology.

Three research areas -- a 7-gas N-Gas Model, toxicant suppressants, and genetic toxicology -- are presented as new research approaches in toxicology. The current 6-gas N-Gas Model predicts the toxic potency of the combustion products of materials based on the toxicological interactions of the fire gases carbon monoxide (CO), carbon dioxide (CO2), low oxygen (O2) concentrations, hydrogen cyanide (HCN), hydrogen chloride, and hydrogen bromide. The present research includes nitrogen dioxide (NO2) in a new 7-gas model which incorporates the synergistic effects of NO2 and CO2, the antagonistic effects of NO2 and HCN, and the additive effects of NO2 with CO and low O2. The area of toxicant suppressants concerns chemicals, which when added to a material, will inhibit or reduce the concentration of a specific toxic gas normally generated during thermal decomposition of that material. The effectiveness of this approach was demonstrated at the US National Institute of Standards and Technology when HCN generation was reduced by 90% and the resultant toxicity of the combustion products was lowered by 50% when a flexible polyurethane (FPU) foam was treated with 0.1% (by weight) cuprous oxide (Cu2O). Although melamine-treated FPU foams are being promoted as more fire safe than standard foams, a melamine-treated foam generated 10 times more HCN than a foam without melamine. The addition of Cu2O to this melamine foam also reduced the HCN generation by 90%. The genetic toxicology research entails the examination of DNA damage that results from the exposure of human cells to various environmental toxicants and gases.

Animals↗

Healing by secondary intention of auricular defects after Mohs surgery.

OBJECTIVE: To evaluate secondary intention healing of full-thickness skin defects of the auricle. Immediate reconstruction of full-thickness skin defects after cancer surgery is an accepted surgical method used to preserve function and to minimize cosmetic deformity. However, healing by secondary intention offers the advantages of optimal cancer surveillance, simplified wound management, and avoidance of reconstructive procedures with their associated costs and potential complications. Accurate prediction of the course of wound healing would allow a rational approach to selection of patients for surgical or nonsurgical repair. DESIGN: We observed 133 patients with full-thickness auricular defects (helix, antihelix, concha, pretragal and tragal area, lobule, and posterior aspect) after Mohs surgery and documented a variety of parameters affecting wound healing, including the location, depth, and size of the wound and use of antibiotics. Patients were examined at intervals and determination was made regarding cosmesis at least 6 months after surgery. RESULTS: All wounds healed by secondary intention within 10 weeks. Analgesics were generally not required. Antibiotics were arbitrarily used in 13% of the patients. Three infections occurred with no permanent disfigurement. CONCLUSIONS: The location of the wound in the auricular subunit is predictive of the cosmetic result. Exposed cartilage is not a contraindication for secondary intention healing. Prophylactic antibiotics are not routinely required when exposed cartilage is present. The results of secondary intention healing are often more cosmetically pleasing than those of surgical repair.

Adult↗

Outcome analysis of Mohs surgery of the lip and chin: comparing secondary intention healing and surgery.

Wounds of the lip and chin resulting from microscopically controlled (Mohs) surgery are often repaired immediately. However, wounds allowed to heal by secondary intention have the advantage of optimal cancer surveillance, simplified wound care, and avoidance of the costs and potential complications associated with reconstructive procedures. Accurate prediction of the course of wound healing would allow a rational approach to selection of surgery or healing by secondary intention. The authors evaluated 105 patients with defects of the lip and chin after Mohs excision for cancer who healed by secondary intention. Forty-six patients treated surgically were followed for comparison. The lip and chin were divided into subunits and the wound location, size, and depth were recorded. Patients were followed at intervals and a final determination regarding cosmesis was made after 6 or more months. It is concluded that the final cosmetic result can be confidently predicted on the basis of location by subunit, size, and depth of the wound.

Adult↗

Uvulopalatopharyngoplasty for snoring: long-term results.

Uvulopalatopharyngoplasty (UPPP) has become a widely practiced procedure in the management of snoring. In a number of studies, all based on short-term follow-up, snoring was reduced or eliminated in 75% to 95% of patients. Because a decline in the initial success rate was casually observed, a formal analysis of the initial and long-term results of UPPP for snoring was made in the present study. From 1985 to 1989, 69 patients with severe habitual snoring were retrospectively analyzed. A scoring system was devised for snoring, and each patient was interviewed regarding the effects of UPPP on his or her snoring 16 to 75 (mean 44) months after surgery. In 60 (87%) of 69 patients, snoring was initially significantly reduced or totally eliminated. After 13 months the success rate dropped to 46% (32 of 69 patients). Most failures occurred between 6 and 12 months of surgery, after which time the success rate remained relatively stable. The authors' conclusion that the long-term success rate of UPPP for snoring declines significantly with time has obvious implications regarding presurgical patient counseling.

Adenoidectomy↗

The development of a new small-scale smoke toxicity test method and its comparison with real-scale fire tests.

A comprehensive methodology has been developed for obtaining and using smoke toxicity data for fire hazard analysis. This bench-scale method can simulate diverse fire conditions and identify extremely toxic smoke under both pre- and post-flashover conditions. However, incidence data show that most of the fire deaths in the U.S. occur outside the room of fire origin from smoke and toxic gases that are generated from a fire under post-flashover conditions. Therefore, the most relevant real-scale combustion conditions to simulate in the bench-scale apparatus would be the post-flashover conditions which are achieved by using radiant heat, a high heat flux, and correcting the bench-scale carbon monoxide (CO) results to agree with CO yields observed in real-scale post-flashover fires. The number of test animals (Fischer 344 male rats) is minimized by using the N-Gas Model to estimate the LC50 value from the chemical analysis of the smoke. The current N-Gas Model predicts the toxicity of complex fire gas mixtures based on a large data base of experimental results of individual and mixed gases that include CO, CO2, reduced O2, HCN, HCl, HBr, and NOx. The prediction is checked with a small number of animal tests and an approximate LC50 value is determined. The bench-scale results have been validated with full-scale room wall burns of a limited number of materials of widely differing characteristics chosen to challenge the system. The toxic potency values are assessed to determine if the smoke from a material or product is unusually or extremely toxic and can then be used in computations of fire hazard.

Animals↗

Nonsurgical repair of perinasal skin defects.

Immediate reconstruction of full-thickness skin defects after cancer surgery is a commonly accepted surgical principle used to preserve function and minimize cosmetic deformity. Healing by secondary intention, however, offers the advantages of optimal cancer surveillance, simplified wound management, and avoidance of reconstructive procedures with their associated costs and potential complications. Accurate prediction of the course of wound healing, and thereby the final functional and cosmetic result, would allow a rational approach to selection of patients for surgical or nonsurgical repair. We observed 282 patients with full-thickness perinasal (glabella, medial canthus, dorsum, sidewall, tip, ala, philtrum, alar base, and nasolabial fold) skin defects after Mohs' surgery and documented a variety of parameters affecting wound healing, including location, depth, and size of the wound. Patients were examined at intervals, and a final determination regarding cosmesis and function was made at 6 months or later. We conclude that the most important considerations in predicting the final functional and cosmetic result include location by subunit, followed by size and depth of the wound.

Adult↗

Analysis of carboxyhemoglobin and cyanide in blood from victims of the Dupont Plaza Hotel fire in Puerto Rico.

Ninety-seven people died from a fire that occurred in the Dupont Plaza Hotel in Puerto Rico on 31 Dec. 1986. All, except four who died later in the hospital, were found dead at the scene. All of the fatalities at the hotel (except for eight) were burned beyond recognition. Blood from seventy-eight of the victims was screened for carboxyhemoglobin at the Institute for Forensic Sciences in Puerto Rico and was then sent to the National Institute of Standards and Technology, Gaithersburg, Maryland, for analysis of carboxyhemoglobin and cyanide concentrations. The blood data indicated that carbon monoxide and hydrogen cyanide, singly or combined, were probably not responsible for the majority of the deaths that occurred in the badly burned victims. On the other hand, the significantly higher carboxyhemoglobin in the nonburned victims indicated that carbon monoxide alone or combined with hydrogen cyanide probably played a major role in the cause of their deaths.

Burns↗

Radiotherapy or surgery for subclinical cervical node metastases.

This retrospective study compared elective neck dissection with elective neck radiotherapy for the control of subclinical nodal metastases. Four hundred ninety-eight patients with head and neck primary cancers and no clinically apparent neck metastases on initial presentation comprised the study population. Each patient was followed up for at least 5 years to detect failure to control neck metastases and control of the primary tumor at the time of neck recurrence. Analysis of neck recurrences occurring in patients with control of the primary tumor showed that there was no statistically significant difference between elective radiation therapy to the neck and elective neck dissection for oral cavity, oropharyngeal, and laryngeal cancers. The only statistically significant difference was noted for hypopharyngeal cancers, with radiation therapy being more effective than surgery.

Carcinoma, Squamous Cell↗