Irreversible shock revisited: mechanical support of the cardiovascular system: a case report and review.
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Adult↗
Biomedical subjects
C Moore
Publications and source records attributed to C Moore.
Health effects of exposure to cyanobacteria (blue-green algae) during recreational water-related activities.
The aim of this study was to investigate effects on health of exposure to cyanobacteria as a result of recreational water activities. Participants, who were aged six years and over, were interviewed at water recreation sites in South Australia, New South Wales and Victoria on selected Sundays during January and February 1995. Telephone follow-up was conducted two and seven days later to record any subsequent diarrhoea, vomiting, flu-like symptoms, skin rashes, mouth ulcers, fevers and eye or ear irritations. On the Sundays of interview, water samples from the sites were collected for cyanobacterial cell counts and toxin analysis. There were 852 participants, of whom 75 did not have water contact on the day of interview and were considered unexposed. The 777 who had water contact were considered exposed. No significant differences in overall symptoms were found between the unexposed and exposed after two days. At seven days, there was a significant trend to increasing symptom occurrence with duration of exposure (P = 0.03). There was a significant trend to increasing symptom occurrence with increase in cell count (P = 0.04). Participants exposed to more than 5000 cells per mL for more than one hour had a significantly higher symptom occurrence rate than the unexposed. Symptoms were not correlated with the presence of hepatotoxins. These results suggest symptom occurrence was associated with duration of contact with water containing cyanobacteria, and with cyanobacterial cell density. The findings suggest that the current safety threshold for exposure of 20,000 cells per mL may be too high.
Adult↗
The influence of forearm crutches on pelvic and hip kinematics in children with myelomeningocele: don't throw away the crutches.
Gait analysis was performed on 16 children with high-sacral-level myelomeningocele who walked with and without crutches to evaluate the influence of crutches on their unique walking pattern. All of the patients used solid ankle-foot orthoses (AFOs). Deviations in coronal and transverse planes improved with assisted walking. The timing of stance phase pelvic depression and the magnitude of stance phase hip abduction improved with crutch walking. Pelvic rotation, which was seven times the normal range of motion during no-crutch walking, decreased to four times normal with crutches. Walking velocity was not significantly different between conditions. The results demonstrated that deviations in pelvic and hip kinematics are related to muscle weakness and improve with crutch use. Crutches enable the patient to transfer some weight bearing to their upper extremities which decreases the demand on weak lower-extremity musculature. This allows them to maintain functional ambulation with a closer to normal gait pattern.
Adolescent↗
Transcriptional activation and transformation by FosB protein require phosphorylation of the carboxyl-terminal activation domain.
The transcription factor AP-1, composed of Fos-Jun dimers, mediates some aspects of the cellular response to growth factors. Transcriptional activation and neoplastic transformation by FosB, a member of the Fos family of proteins, require the presence of a potent C-terminal activation domain. Here we show by mutational analysis that the FosB C-terminal domain has a proline-based motif that is essential for both of these functions. Phosphopeptide mapping experiments show that the C terminus of FosB is phosphorylated within a cluster of functionally redundant serine residues that is adjacent to this proline-based motif. Mutation of these serine residues to alanine severely reduces the ability of this region to function as an activation domain and inhibits the ability of FosB protein to function as a transforming protein. Several observations suggest that the kinase responsible for phosphorylation of these sites is distinct from the mitogen-activation protein kinases and stress-activated protein kinases. Our results show that transcriptional activation and neoplastic transformation by the FosB protein are dependent on phosphorylation within the C terminus. This form of control may provide a potential mechanism of signal integration at the level of a single transcription factor.
Amino Acid Sequence↗
Molecular cloning and sequence of the ovine gastrin gene.
A clone encoding ovine preprogastrin was isolated from a sheep genomic library. The deduced 104 amino acid sequence of ovine preprogastrin was 92% and 68% identical to the sequences of bovine and human preprogastrin, respectively. While the similarity was greatest in the gastrin-17 sequence, and unexpected similarity was also observed in the N-terminus of mature progastrin.
Amino Acid Sequence↗
Gastric volvulus: an old disease process with some new twists.
Gastric volvulus has been described in the medical literature for centuries. The acute presentation of gastric volvulus is dramatic and not often missed, and it is this type that is usually quoted in the literature and case citations. The subacute or chronic type, however, is frequently not recognized early in its presentation because it is accompanied by vague and nonspecific symptomatology suggestive of other abdominal processes. We review the classification, diagnosis, and treatments of gastric volvulus and highlight the significance of the chronic volvulus presentation through case descriptions, including endoscopic and radiographic features.
Aged↗
Grandma knew which medicines were best.
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Complementary Therapies↗
[Effect of ethinyl estradiol-dienogest combination on serum androgen concentrations].
Antiandrogens or progestins with an antiandrogenic component usually have only a weak antigonadotropic activity. It is thus possible that the antiandrogenic effect on the cellular level is cancelled or at least reduced by an increased ovarian androgen production. The aim of the four submitted clinical studies of the progestin and antiandrogen dienogest alone (0.5-2 mg/day) or of a combined regimen of ethinylestradiol (0.03 mg) plus dienogest (2 mg) (EE/DNG) was to examine the influence on the serum androgen and SHBG concentrations as well as on the serum FSH, LH, progesterone and 17 beta-estradiol concentrations in young women. Like the progesterone derivatives, dienogest has a relatively low antigonadotropic activity. Inhibition of ovulation is mainly produced by peripheral mechanisms such as the reduction of preovulatory 17 beta-estradiol secretion. Dienogest alone has no significant effects on the serum SHBG and androgen concentrations. Unlike this, the combination of EE plus DNG markedly increases SHBG concentrations (to 2.1-3.7 fold the basal levels). The decrease in serum androgens with total testosterone (by 17 and 40%), free testosterone (by 48 and 54%) and dehydroepiandrosterone sulfate (by 51%) corresponds to the values shown in the literature for other oral contraceptives with modern progestins. EE/DNG does not affect the serum concentrations of 5 alpha-dihydrotestosterone (DHT), although the marker of the peripheral transformation from T to DHT, androstanediol glucuronide, is distinctly reduced (by 38%). In a double-blind comparison no differences are found between EE/DNG and a regimen combining 0.02 mg of ethinylestradiol and 0.150 mg of desogestrel. Solely the SHBG concentrations, with EE/DNG, as expected, are significantly higher. In a sequential regimen, dienogest, chlormadinone acetate and desogestrel (progestins without binding to SHBG) enhance the inhibitory effect of ethinylestradiol sulfonate on free testosterone, whereas norethindrone acetate and levonorgestrel (progestins with a strong binding to SHBG) reduce this effect of the estrogen significantly. These results exclude the possibility that the very distinct antiandrogenic effect of dienogest on a cellular level is neutralised or reduced by an increased systemic supply of androgen.
Adolescent↗
Teratogenicity of high vitamin A intake.
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Abnormalities, Drug-Induced↗
Post-immunization pneumococcal antibody titers and IgG subclasses.
IgG antibodies against pneumococcal polysaccharides are found predominantly within IgG subclass 2. We wished to evaluate retrospectively IgG subclasses and post-immunization pneumococcal antibody titers in children with recurrent respiratory infections. We examined total immunoglobulin levels and IgG subclasses, as well as pneumococcal antibody titers against serotypes 3, 7F, 9N, and 14 present 4-6 weeks after pneumococcal immunization in 56 children 2-18 years old. Titers > 200 ng Ab N/ml to any of the 4 serotypes tested were arbitrarily considered protective. Four patients did not have protective antibody levels against any of the 4 serotypes tested following vaccination. Of those, 3 had normal IgG subclass levels and 1 had an IgG2 subclass deficiency. Of 3 additional patients with IgG2 deficiency, 2 had protective antibody levels to only 1 serotype and 1 had protective antibody levels to 2 serotypes. Furthermore, in 2 patients with undetectable IgG2 at the time of immunization, the response was only transient. We conclude that patients with IgG2 deficiency may not develop protective antibody levels to all pneumococcal serotypes and that some may have deficient memory for IgG anti-pneumococcal polysaccharide antibodies.
Adolescent↗
The trouble with cognitive subtraction.
In this paper we present a critique of pure insertion. Pure insertion represents an implicit assumption behind many (but not all) studies that employ cognitive subtraction. The main contention is that pure insertion is not valid in relation to the neuronal instantiation of cognitive processes. Pure insertion asserts that there are no interactions among the cognitive components of a task. It is possible to evaluate and refute this assumption by testing explicitly for interactions using factorial experimental designs. It is proposed that factorial designs are more powerful than subtraction designs in characterizing cognitive neuroanatomy, precisely because they allow for interactions and eschew notions like pure insertion. In particular we suggest that the effect of a cognitive component (i.e., an effect that is independent of other components) is best captured by the main (activation) effect of that component and that the integration among components (i.e., the expression of one cognitive process in the context of another) can be assessed with the interaction terms. In this framework a complete characterization of cognitive neuroanatomy includes both regionally specific activations and regionally specific interactions. To illustrate our point we have used a factorial experimental design to show that inferotemporal activations, due to object recognition, are profoundly modulated by phonological retrieval of the object's name. This interaction implicates the inferotemporal regions in phonological retrieval, during object naming, despite the fact that phonological retrieval does not, by itself, activate this region.
Attention↗
Sequence analysis and immunolocalisation of phosphatidylethanolamine binding protein (PBP) in human brain tissue.
We have cloned and sequenced cDNA corresponding to human brain phosphatidylethanolamine binding protein (PBP) and have used the resultant data to generate PBP-specific anti-peptide antisera for immunohistochemical studies. The distribution of PBP was assessed immunohistochemically in sections from multiple regions of neonatal brain and spinal cord, including spinal nerve roots. Strong PBP immunoreactivity was present in the cytoplasm of oligodendrocytes in the white matter and Schwann cells in the nerve roots. There was only weak immunostaining within the neurones and neuropil. The findings are in keeping with a role for PBP in the organisation of phospholipids in the myelin sheath.
Base Sequence↗
Preimmunization and postimmunization pneumococcal antibody titers in children with recurrent infections.
BACKGROUND: Patients with recurrent infections and normal IgG levels may have an abnormal response to pneumococcal polysaccharides. The ability to develop antibodies against different pneumococcal polysaccharides develops gradually in the first years of life, but the sequence of development and the influence of preexisting antibody titers has not been defined. METHODS: Preimmunization and postimmunization IgG antibody titers against pneumococcal serotypes 3, 7F, 9N, and 14 were evaluated in a population of 100 1- to 18-year-old children referred to a pediatric allergy-immunology clinic because of recurrent respiratory infections. None of the patients had a known immunodeficiency syndrome; all had normal total IgG levels. Postimmunization antibody levels were obtained 4 to 6 weeks after immunization. Patients less than/=5 years of age who failed to develop antibody levels above 200 ng Ab N/mL against any serotype and older patients who failed to develop these levels against a second serotype in addition to serotype 3 were considered for IgG replacement therapy. RESULTS: Prior to immunization, 50% of 51 patients did not have protective antibody levels against any of the serotypes tested. Immunization induced a high response to serotype 3 in all age groups, but responses to serotypes 7F and 14 increased with age. Five of 78 patients (6.4%) failed to develop protective antibody levels against any serotype tested. Three of these patients had clinical criteria that justified the use of IgG replacement therapy; all improved. Three patients were re-immunized 1 to 2 years after the first immunization and all developed protective levels of antibodies against serotype 3 after the second immunization. CONCLUSION: We conclude that, although measurement of antibody levels against pneumococcal serotype 3 allows a good differentiation of patients who are able to develop anti-polysaccharide antibodies from those who are not, further studies of the development of specific antibodies against other vaccine serotypes in normal populations of different ages are needed to define a normal response to pneumococcal polysaccharides.
Adolescent↗
Fetal cocaine exposure: analysis of vernix caseosa.
Preliminary data regarding the use of vernix caseosa (VC) as an alternative to other biological specimens for the determination of fetal cocaine exposure are presented. Advantages of VC analysis include its presence on all newborn babies, historical record of drug exposure, and ease of collection and storage. Fifteen samples of vernix caseosa-five from babies known to be cocaine-exposed because of a positive benzoylecgonine result from the urine and umbilical cord blood and ten from nonexposed neonates-were analyzed for the presence of cocaine and metabolites. VC samples from three of the five neonates known to be cocaine-exposed were positive for cocaine or its metabolites, the other two had little or no remaining specimen. The remaining ten were negative.
Chromatography, Gas↗
Extraconal bupivacaine in scleral buckling procedures.
BACKGROUND: Intraoperative retrobulbar bupivacaine injection provides effective analgesia after scleral buckling procedures performed under general anesthesia, but is associated with significant risks. METHODS: The safety and analgesic efficacy of an extraconal technique using a blunt cannula was evaluated. Forty patients undergoing scleral buckling procedures with general anesthesia were randomized to intraoperative extraconal bupivacaine injection (bupivacaine group. n = 21) or to no such treatment (control group, n = 19). General anesthetic and postoperative analgesia regimens were standardized. Analgesia requirements, pain, nausea, and sedation levels were graded at four intervals the first 24 hours after surgery. Chemosis was assessed 1 day after surgery, and ocular motility was assessed at 1 day, 1 week, and subsequent review. RESULTS: Maximum, 0 to 2-hour, and 4 to 6-hour pain levels were lower in the bupivacaine group than the control group (Wilcoxon rank sum, P < 0.005, < 0.005, < 0.01, respectively). Postoperative analgesia was required within the first 24 hours of surgery by all patients in the control group, but by only 12 of 21 patients (57%) in the bupivacaine group (Fisher's exact test, P = 0.001). Ptosis with minimal supraduction defect was noted at first postoperative examination in two patients who had undergone extraconal bupivacaine injection but resolved within 1 week. No other complication was encountered. CONCLUSION: Intraoperative extraconal bupivacaine injection appears to be a safe and effective method for reducing pain and analgesia requirements after scleral buckling procedures performed under general anesthesia.
Adolescent↗
Pilot study of ambulatory infusional delivery of a multidrug regimen: ifosfamide, carboplatin and etoposide (ICE).
PURPOSE: To determine the feasibility for administering ICE (ifosfamide, carboplatin, and etoposide) using an ambulatory infusional schedule for each of the three agents in a design that sequentially alternates those agents that are not compatible as an admixture. PATIENTS AND METHODS: Forty-one patients received ICE administered as follows: ifosfamide (500 mg/M2/day) without mesna days 1 to 7 and 14 to 21; carboplatin (30 or 40 mg/M2/day) and etoposide (30 to 40 mg/M2/day) admixed as a single solution infused day 7 to 14. Patients were monitored weekly and cycles repeated at five-week intervals. RESULTS: Seventy-nine courses of therapy were analyzed. Forty-one patients received a median of two cycles with a range of one to five cycles. The only significant toxicity was hematologic with 11 patients experiencing grade III neutropenia and 7 patients grade III thrombocytopenia (18%). Eleven patients did develop significant anemia requiring transfusion and/or the use of erythropoietin. Tumor responses were observed in 7 of 24 evaluable patients, 4 of whom had lung cancer, 2 with small cell with no prior therapy and 2 with nonsmall cell with prior chemotherapy. CONCLUSION: Ambulatory infusion of ICE using an alternating sequence is feasible, and although the dose per cycle of carboplatin and etoposide is less than that of conventional bolus schedules for either single agent or combination programs, the ability to deliver this combination of agents in an ambulatory setting and without mesna substantially reduces the cost. Phase II studies of ambulatory infusion ICE in nonsmall cell lung cancer, lymphoma, and sarcoma are a reasonable next step.
Adenocarcinoma↗
Pilot study of ambulatory infusional delivery of a multidrug regimen: cisplatin, 5-fluorouracil and leucovorin (PFL) +/- etoposide.
PURPOSE: To determine the feasibility of ambulatory infusional administration 24 hours per day, 7 days per week of a three-drug regimen of cisplatin or carboplatin, leucovorin, and 5-fluorouracil (5-FU) (PLF) utilizing an alternating weekly sequential design and to introduce infusional etoposide as PLEF to the regimen. PATIENTS AND METHODS: Forty-three patients with diverse malignancies received a sequential infusion of 5-FU 200 mg/M2/day on days 1 to 14 and 21 to 35 with leucovorin admixed for day 1 to 7 and 21 to 28. Cisplatin (20 patients) or carboplatin (23 patients) infusion was administered at a dose of 10 mg/M2/day or 30 mg/M2/day, respectively, day 7 to 14 and 35 to 42. Cycles were planned to be repeated consecutively in the absence of toxicity in patients with stable or responding disease. Sixteen patients also received etoposide 30 mg/M2/day as an admixture concomitant with administration of the platinum analogue. Therefore, the distribution of therapies was PLF 19, CLF 8, PLEF 14, and CLEF 2. RESULTS: A total of 63 courses of PLF +/- E was administered as outlined above. Hematologic toxicity was minimal with or without the addition of etoposide. Sixteen percent of patients developed an elevated creatinine with a median of 1.6 and a range of 1.6 to 3.2 mg %. Tumor responses were observed in seven of fourteen evaluable patients with squamous cell carcinoma of the lung (all of whom received concomitant etoposide). In addition, one patient with metastatic gallbladder cancer achieved a complete clinical response. CONCLUSION: Ambulatory infusional PLF with carboplatin or cisplatin using sequentially alternating delivery of the component antineoplastic agents is feasible and active with minimal toxicity. The addition of infusional etoposide to the PLF regimen does not substantially increase hematologic toxicity. Extended phase II studies in aerodigestive cancers are ongoing and a phase III trial comparing this ambulatory regimen to short-term PLF infusion (5-day) may be justified to compare the relative cost and benefits of the two schedules.
Adult↗
Cranial bone grafting: biodegradable versus titanium fixation in a rabbit model.
Rigid internal fixation with miniplates and screws has enabled reconstructive surgeons to position bony segments precisely. Unfortunately, our present systems have been associated with a potential adverse effect on ultimate craniofacial growth and development. Also, they may be palpable, necessitating secondary procedures for removal of the hardware. We have been involved in an ongoing study evaluating the efficacy of a commercially developed biodegradable system. In this study, we compared biodegradable lag screw fixation with traditional titanium screw fixation in full-thickness, membranous bone grafts harvested from the zygomatic arches to the snout in a rabbit model. The results were compared with standard hematoxylin and eosin stains and laser densometry. Although this study adds further credence to the resorption of bone grafts, those secured with the polyglycolic acid screws demonstrated significantly less resorption than those maintained in position by traditional methods.
Animals↗