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Biomedical subjects

D Allen

Publications and source records attributed to D Allen.

At least 91 records · Page 5Linked to original sources

Expression of a CD3 epsilon transgene in CD3 epsilon(null) mice does not restore CD3 gamma and delta expression but efficiently rescues T cell development from a subpopulation of prothymocytes.

The TCR-associated CD3 complex consists of four subunits, i.e. CD3 gamma, delta, epsilon and zeta, which are expressed very early in T cell development prior to the expression of the TCR and the pre-TCR alpha chain. It is unclear whether the expression of each CD3 protein is independent of, or is influenced by, other CD3 subunits. To study whether CD3 epsilon regulates expression of CD3 gamma and delta genes, we generated a strain of CD3 epsilon-deficient mice termed CD3 epsilon(delta P/delta P) (epsilon(delta P)), in which the promoter of CD3E was disrupted, and subsequently reconstituted these mice with a CD3 epsilon transgene. In the epsilon(delta P) mice, T cell development is arrested at the double-negative stage and targeting the CD3 epsilon gene caused severe inhibition of CD3 gamma and delta gene expression. Introduction of the CD3 epsilon transgene did not restore CD3 gamma and delta expression. However, a very small fraction of prothymocytes that expressed CD3 gamma and delta was rescued upon reconstitution of the CD3 epsilon transgene. Remarkably, this rescue led to a very efficient differentiation and maturation of thymocytes, resulting in a significant T cell population in the periphery. These results demonstrate that CD3 epsilon does not regulate expression of CD3 gamma and delta genes, and underscore the capacity of each prothymocyte to give rise to a large number of mature peripheral T cells.

Animals↗

Development of colonic adenocarcinomas in a mouse model of ulcerative colitis.

Mice deficient in both interleukin-2 and beta 2-microglobulin expression (Beta 2mullnull x IL-2null mice) develop an inflammatory disease of the colon resembling ulcerative colitis. To examine long-term complications of disease in these mice, a group of 34 Beta 2mnull x IL-2null mice was monitored for 6-12 months. Development of clinical disease was assessed by wasting, general appearance, and diarrhea. Further analysis included histologic examination of the distal colon for colitis, staining of CD4+ T cells for surface activation markers, and cytoplasmic staining of CD4+ T cells for IFN-gamma and TNF-alpha. These older Beta 2mnull x IL-2null mice had activated CD4+ T cells as assessed by surface markers on flow cytometry. Cytoplasmic staining revealed IFN-gamma production, but not TNF-alpha production by CD4+ T cells. The majority of these older Beta 2mnull x IL-2null mice continued to have colitis on histology. However, they lived much longer and had less wasting in comparison to IL-2null mice. At necropsy, 11 (32%) of 34 of the Beta 2mnull x IL-2null mice had tumors in the proximal half of the colon. Histologic examination confirmed these tumors to be adenocarcinomas. These mice may be useful as a model for studying carcinogenesis in chronic colitis.

Adenocarcinoma↗

The use of large loop excision of the transformation zone in management problems of cervical intraepithelial neoplasia.

We studied 2 groups of women whose management is controversial: those with cervical intraepithelial neoplasia (CIN) grade 2 or 3 on smear, but only CIN grade 1 or no abnormality on target biopsy (Group 1), and those with persistent CIN grade 1 on smear and up to CIN 1 on biopsy (Group 2). We set out to assess whether large loop excision of the transformation zone (LLETZ) was an acceptable method of treating these 2 groups of women. A review of 100 consecutive patients was undertaken. There were 71 women in Group 1 and 29 women in Group 2. The LLETZ procedures were performed under local analgesia and no immediate problems were encountered. Delayed haemorrhage requiring vaginal packing and admission to hospital occurred in 1 patient. In Group 1, histopathology of the LLETZ biopsies showed CIN 2 or 3 in 29 (40.8%) of the women, CIN 1 in 24 (33.8%) and no CIN in 18 (25.3%), and in Group 2, CIN 2 or 3 was seen in 5 (17.2%) of the women, CIN 1 in 11 (37.9%) and no CIN in 13 (44.8%). At 12 months completed follow-up, 4 patients in Group 1 had recurrent CIN 1 or equivocal CIN 1 and 1 patient from Group 2 had recurrent CIN 1, giving an overall recurrence rate of 5 of the 94 patients who completed follow-up (5%). We concluded that LLETZ was a useful procedure in both groups. In Group 1 the provision of a histological diagnosis on the LLETZ biopsy was a check on the accuracy of the cervical smear report. In Group 2, LLETZ offered the advantage of rapidly returning the smear to normal in most patients, and the diagnosis and treatment of those women who actually had a high-grade lesion.

Adolescent↗

Measuring outpatient resource use and case mix in ophthalmology in north east England.

OBJECTIVES: To test the extent to which two existing ambulatory case mix measures (Ambulatory Visit Groups and Ambulatory Patient Groups) and other variables can explain resource use variations in ophthalmic outpatient visits. DESIGN: Three week prospective study of three consultant outpatient clinics. SETTING: One ophthalmic hospital (Sunderland Eye Infirmary, Sunderland, Tyne and Wear) and three outreach clinics (South Tyneside District Hospital, South Shields, Tyne and Wear; Dryburn Hospital, Durham, Co Durham; and Hartlepool General Hospital, Hartlepool, Cleveland). SUBJECTS: 325 patients who visited ophthalmic outpatient clinics. MAIN OUTCOME MEASURES: Mean consultation time and mean cost distributions by case mix group, analysed by analysis of variance. RESULTS: Ambulatory case mix measures can explain some of the variation in resource use for outpatient visits, but different measures differ in the extent to which they can do so. Clinicians' behaviour also accounts for a significant amount of such variation. Simpler measures of visit type, without diagnostic or procedure information, do not explain resource use variations. CONCLUSIONS: Existing measures perform reasonably well, but their data requirements may preclude their introduction in the National Health Service. Caution is required in advocating simpler measures, however. The influence of clinical practice on resource use variations is important; in this study, most differences between clinicians were not attributable to differences in case mix.

Analysis of Variance↗

Clinical and neurocognitive effects of clozapine and risperidone in treatment-refractory schizophrenic patients: a prospective study.

BACKGROUND: Few controlled studies have compared the efficacy of clozapine and risperidone in treatment-refractory schizophrenic patients. The present study investigates the efficacy of both clozapine and risperidone on psychopathologic and neurocognitive measures in a prospective 12-week open-label trial in treatment-refractory schizophrenic patients from state psychiatric hospitals. METHOD: Thirty-five DSM-IV schizophrenic patients with a documented history of nonresponse to typical neuroleptics were treated with either clozapine or risperidone. Response was assessed every 2 weeks by independent raters with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) scale, neurologic rating scales, and plasma drug levels. Neurocognitive tests were administered at baseline and week 12. RESULTS: Both clozapine and risperidone brought about significant (p < .003) overall improvement in psychopathology. However, clozapine was numerically superior to risperidone on PANSS total scores and PANSS positive, negative, excitement, and cognitive factors. Extrapyramidal side effects were minimal for clozapine, whereas some were present for risperidone. Patients taking risperidone improved significantly in the beginning stages of the study and remained stable thereafter. Patients taking clozapine showed a gradual improvement that occurred over the entire length of the trial. Neurocognitive measures showed minimal improvement and did not differentiate between the 2 medication groups. CONCLUSION: Both clozapine and risperidone were comparably effective across a wide spectrum of psychopathologic measures. While the efficacy of clozapine was only numerically superior to that of risperidone, it was associated with fewer extrapyramidal side effects and with progressive improvement over the 12-week treatment period, suggesting that in longer trials clozapine may prove to be superior to risperidone in neuroleptic-refractory patients.

Adult↗

Review of telephone consults to the practice area--Part 2.

The overall volume and complexity of calls in this review reflects the pace and stresses of most current health care settings in Alberta. This synopsis only highlights some areas of concern and does not encompass the nature of every call. The consulting services are available to all registered nurses and all Albertans- and it is clear from this review that callers are contacting the AARN in record numbers with a wide range of practice questions and concerns.

Alberta↗

[Risks and recommendations in Bechterew disease. Paraparesis after epidural anesthesia].

We describe a case of paraparesis caused by an epidural haematoma in a 74-year-old man with advanced ankylosing spondylitis who received combined epidural and general anaesthesia for graft repair of an aneurysm of the abdominal aorta. Before the induction of general anaesthesia, an epidural catheter was inserted at the level of thoracic vertebrae 10-11 without difficulty or signs of bleeding. Total analgesia and paralysis of the legs in the early postoperative period raised suspicions of the presence of an epidural haematoma, which was confirmed by magnetic resonance tomography. Aspiration of the epidural catheter yielded 13 ml of blood. Despite early surgical decompression after transfer to a regional hospital, the patient remains paraparetic. We wish to highlight the risks of epidural anaesthesia in cases of ankylosing spondylitis, and to stress the need of routine control of motor function after epidural anaesthesia.

Aged↗

Finding a voice.

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Adaptation, Psychological↗

Telephone follow up for older people discharged from A&E.

This article reports on a pilot study to evaluate the benefits of providing a telephone follow-up service for patients over 75 years discharged directly from A&E. A liaison nurse retrieved details of patients from the department's attendance records and, wherever possible, telephoned the patient/carer/family to assess how they were coping following discharge. Advice and reassurance were offered as required and referrals made to the relevant statutory/voluntary agencies as appropriate. The author highlights a range of benefits from the service and recommends that such a service could be tailored to the needs of the local population.

Aged↗

Dobson's choice.

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Attitude of Health Personnel↗

CD16-expressing CD8alpha alpha+ T lymphocytes in the intestinal epithelium: possible precursors of Fc gammaR-CD8alpha alpha+ T cells.

T lymphocytes normally express their Ag receptors in association with the CD3 proteins, which include CD3zeta. In CD3zeta eta(null) mice thymic and peripheral T lymphocytes do not express the TCR/CD3 complex on their surface due to retention in the endoplasmic reticulum of the remaining polypeptide chains. However, intestinal intraepithelial lymphocytes (iIEL) of CD3zeta eta(null) mice do express surface TCR, because the Fc epsilonRI gamma chain replaced the CD3zeta chain in the TCR/CD3 complex. Here we report that in a subset of CD8alpha alpha+ iIEL the presence of the Fc epsilonRI gamma chain could be accounted for by the surface expression of the Fc gammaRIII(CD16) complex. Because in wild-type (wt) mice only CD16+ iIEL coexpressed Fc epsilonRI gamma and CD3zeta, we concluded that the presence of Fc epsilonRI gamma was dictated by its required participation of CD16 complex. CD8alpha alpha+ iIEL bearing CD16 and B220 were also detected in the intestinal mucosa of RAG-2(null) mice from 12 days after birth onward. Two independent experimental settings were used in an attempt to demonstrate that CD16+ iIEL matured into CD16- T cells. First, in the RAG-2(null) mice, iIEL responded to in vivo administration of an anti-CD3epsilon mAb by progression to a more mature stage of development, characterized by a loss of CD16 and B220. Secondly, a conversion to CD16- iIEL occurred upon transfer of wt CD16+ iIEL into RAG-2(null) mice. We conclude from these experiments that in both RAG-2(null) and wt mice, a precursor/progeny relationship may exists between CD16+ B220+ CD8alpha alpha+ and CD16- B220- CD8alpha alpha+ iIEL.

Animals↗