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Biomedical subjects

D Little

Publications and source records attributed to D Little.

At least 37 records · Page 2Linked to original sources

Linkage of familial schizophrenia to chromosome 13q32.

Over the past 4 years, a number of investigators have reported findings suggestive of linkage to schizophrenia, with markers on chromosomes 13q32 and 8p21, with one recent study by Blouin et al. reporting significant linkage to these regions. As part of an ongoing genome scan, we evaluated microsatellite markers spanning chromosomes 8 and 13, for linkage to schizophrenia, in 21 extended Canadian families. Families were analyzed under autosomal dominant and recessive models, with broad and narrow definitions of schizophrenia. All models produced positive LOD scores with markers on 13q, with higher scores under the recessive models. The maximum three-point LOD scores were obtained under the recessive-broad model: 3.92 at recombination fraction (theta).1 with D13S793, under homogeneity, and 4.42 with alpha=.65 and straight theta=0 with D13S793, under heterogeneity. Positive LOD scores were also obtained, under all models, for markers on 8p. Although a maximum two-point LOD score of 3.49 was obtained under the dominant-narrow model with D8S136 at straight theta=0.1, multipoint analysis with closely flanking markers reduced the maximum LOD score in this region to 2. 13. These results provide independent significant evidence of linkage of a schizophrenia-susceptibility locus to markers on 13q32 and support the presence of a second susceptibility locus on 8p21.

Canada↗

A medical school-based program to encourage native Hawaiians to choose medical careers.

Native Hawaiians are highly underrepresented in the field of medicine, both nationally and in Hawaii. Since 1991, the Native Hawaiian Center of Excellence (funded by the Bureau of Health Professions) at the John A. Burns School of Medicine in Honolulu has developed programs to encourage Native Hawaiians to enter and complete medical school. In this article, the authors focus on a revised version of a six-week summer enrichment program for high school students developed by the Center in 1995 and funded by the Hawaii State Department of Education and the federal government. The authors trace the difficulties in attracting Native Hawaiian students and how these difficulties were overcome. They show that once Native Hawaiians have entered the academically rigorous, culturally rich program, their academic and career ambitions have been kindled, and some are planning careers in medicine. The history of the program illustrates that a committed medical school and dedicated individuals in the community, with the support of the federal and state governments, can increase interest among underrepresented students in medical and other health professions careers. Eventually, when such students graduate, there is a likelihood that some of them will go back to serve the health needs of their communities.

Career Choice↗

A study of immunological responses of sheep clinically-affected with paratuberculosis (Johne's disease). The relationship of blood, mesenteric lymph node and intestinal lymphocyte responses to gross and microscopic pathology.

Nineteen adult sheep diagnosed as having clinical paratuberculosis (Johne's disease) and 16 unaffected controls were examined in this study. Animals were tested for the presence of circulating antibodies of Mycobacterium avium ssp. paratuberculosis (M. a. paratuberculosis) and lymphocytes derived from the blood, mesenteric lymph nodes and intestines were examined for cell-mediated immune (CMI) responses to Johnin pure protein derivative (Johnin-PPD: J-PPD). Bacteriological examinations were carried out on faeces and tissues and any mycobacterial isolates identified as M. a. paratuberculosis (IS900+) or M. avium ssp. silvaticum (M. a. silvaticum) (IS901+) by polymerase chain reaction (PCR). Full necropsy and histopathological studies were performed and diseased animals were categorised on the basis of having a lepromatous or tuberculoid form of intestinal pathology. Unaffected control sheep were generally antibody-negative and demonstrated varying CMI responses to J-PPD. Clinically-affected animals were almost always antibody-positive with variable CMI responses. A correlation was observed between the histological lesion type in the intestine and the cellular immune response. Tuberculoid-type lesions were associated with strong CMI responses in lymphocytes derived from the peripheral blood, mesenteric lymph node and intestine, whereas lepromatous-type lesions were associated with weak CMI responses in all tissues examined.

Animals↗

Music increases satisfaction in elderly outpatients undergoing cataract surgery.

PURPOSE: Music has long been known to reduce anxiety, minimize the need for sedatives, and make patients feel more at ease. The purpose of the study was to evaluate the effect of music in elderly outpatients undergoing elective cataract surgery with retrobulbar block and monitored anaesthetic care using fentanyl or alfentanil and midazolam. METHODS: One hundred and twenty one patients were prospectively and randomly assigned to hear: relaxing suggestions, white noise, operating room noise or relaxing music via audio-cassette headphones. Vital signs were documented before and after retrobulbar block and every 15 min thereafter. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) before and after surgery. Visual analogue scales (VAS) were used to assess anxiety and patient satisfaction postoperatively with a standardized questionnaire. Between group comparisons were made using Chi-Square, or ANOVA, where appropriate. RESULTS: There were no differences between groups in STAI or anxiety VAS scores at any time. Differences were noted in systolic blood pressure, but not in other vital signs. Patients' ratings of the whole operative experience, satisfaction with the tape played, general level of relaxation and preference for the chosen tape for subsequent surgery were different (music > relaxing suggestions > white noise and OR noise, P < 0.05). CONCLUSIONS: Elderly patients undergoing cataract surgery under retrobulbar block were more satisfied with their experience if they heard relaxing music, rather than relaxing suggestions or white noise or OR noise. The type of auditory stimuli to which the patients were exposed did not influence the level of anxiety.

Aged↗

Hemorrhagic shock and encephalopathy syndrome. An unusual cause of sudden death in children.

Hemorrhagic shock and encephalopathy syndrome (HSES) is a sudden-onset symptom complex occurring in previously healthy infants and children. It was first described in 1983 in the United Kingdom in 10 infants. Subsequently, > 140 cases have been reported worldwide, although no cases have been previously reported in the forensic literature. Typically the child presents with fever, shock, encephalopathy with coma and seizures, evidence of hemorrhage, and diarrhea. Laboratory investigation reveals falling hemoglobin and platelet counts, renal impairment, evidence of disseminated intravascular coagulation, metabolic acidosis, and raised serum transaminases. Microbiological cultures are uniformly negative. The condition has a high mortality and morbidity. The etiology is unknown and may be multifactorial. However, hyperpyrexia appears to play a central role in pathogenesis. The diagnosis of HSES in the deceased child is one of exclusion and requires a careful antemortem history as well as a thorough autopsy with toxicological and microbiological investigations. A case of HSES is reported and the literature reviewed.

Brain Diseases↗

Screening blood spots for inborn errors of metabolism by electrospray tandem mass spectrometry with a microplate batch process and a computer algorithm for automated flagging of abnormal profiles.

Metabolic profiling of amino acids and acylcarnitines from blood spots by automated electrospray tandem mass spectrometry (ESI-MS/MS) is a powerful diagnostic tool for inborn errors of metabolism. New approaches to sample preparation and data interpretation have helped establish the methodology as a robust, high-throughput neonatal screening method. We introduce an efficient 96-well-microplate batch process for blood-spot sample preparation, with which we can obtain high-quality profiles from 500-1000 samples per day per instrument. A computer-assisted metabolic profiling algorithm automatically flags abnormal profiles. We selected diagnostic parameters for the algorithm by comparing profiles from patients with known metabolic disorders and those from normal newborns. Reference range and cutoff values for the diagnostic parameters were established by measuring either metabolite concentrations or peak ratios of certain metabolite pairs. Rigorous testing of the algorithm demonstrates its outstanding clinical sensitivity in flagging abnormal profiles and its high cumulative specificity.

Algorithms↗

A fatality due to moclobemide.

A fatality due to ingestion of the antidepressant drug moclobemide is reported. Moclobemide is a selective and reversible inhibitor of monoamine oxidase type A. Previous reports have suggested that it is a safe drug even when taken in large quantities. The few reported fatalities have all been ascribed to serotonin syndrome, due to an interaction between moclobemide and other serotonergic agents. A 48-year-old woman with a history of depression and suicide attempts was found deceased at home. Autopsy revealed no evidence of significant natural disease or injury. Toxicologic analysis was performed and drug levels measured by capillary gas chromatography. The blood concentration of moclobemide was 137 mg/L and the liver concentration was 432 mg/kg. Low levels of diazepam, nordiazepam, and trifluoperazine were also detected. Death was considered to be due to acute poisoning by moclobemide. This case report is the first, to our knowledge, where death has been attributed to the toxic effects of moclobemide alone.

Antidepressive Agents↗

The pathology of ovine paratuberculosis: gross and histological changes in the intestine and other tissues.

In sheep clinically affected with paratuberculosis, two distinct forms of microscopical pathology were recognized, related to a high or a low degree of mycobacterial colonization ("multibacillary" or "paucibacillary" presence). These forms were characterized by different types of cellular infiltrate in the ileal mucosa and submucosa. Statistical analysis demonstrated strong correlations between the presence of large numbers of acid-fast organisms and macrophage infiltration, and between small numbers and lymphocyte infiltration. Correlations also existed between high numbers of acid-fast bacteria and a positive serum antibody test results; and between the presence of giant cells and lymphocytes in the gut. This study suggests that in ovine paratuberculosis the same clinical and gross pathological changes can result from different pathogenetic mechanisms.

Animals↗

Phenotypic characterisation of intestinal lymphocytes in ovine paratuberculosis by immunohistochemistry.

Characterisation of the T-cell subsets in intestinal lesions in sheep with paratuberculosis may contribute to our understanding of the pathogenesis of this disease. To determine the phenotype and distribution of lymphocytes in the normal sheep intestinal mucosa and in Mycobacterium avium subspecies paratuberculosis infected sheep, immunohistochemistry was performed on 12 normal sheep and 18 naturally infected, clinically diseased sheep of which 12 showed lepromatous and six tuberculoid forms of the disease. Immunoperoxidase staining was carried out on frozen sections of ileum using monoclonal antibodies against ovine CD4, CD8, and gamma delta T-cell receptor (TCR) markers. In all three sample groups, cells appeared to be non-randomly distributed throughout the lamina propria. Higher densities of lymphocytes were present in villus than in crypt areas. CD8+ cells were located principally around the epithelial basement membrane, whereas CD4+ cells were localised towards the central villus area of the lamina propria. Lymphocytes bearing the gamma delta T-cell receptor were more widely distributed, both in epithelial and lamina propria compartments. Ileum with tuberculoid lesions had higher densities of CD4 and gamma delta T-cell subsets while lepromatous lesions had lower densities of CD4 and CD8 cells compared with normal tissues. The median relative percentage of CD4+ cells was increased and that of CD8+ cells decreased in tuberculoid cases, with a corresponding increase in the CD4:CD8 ratio, while the relative percentage of gamma delta + cells was increased in lepromatous cases.

Animals↗

Microadenomas of the human pituitary.

Four hundred and thirty-four pituitary glands from an unselected autopsy series were examined to investigate the incidence and immunohistochemical nature of occult pituitary microadenomas. Fourteen tumors (3.2%) were identified. The ages of the affected patients varied from 11 to 86 yrs, with no age predominance. Males and females were similarly affected. Nine of the microadenomas were available for immunoperoxidase staining. Adrenocorticotropic hormone, follicle stimulating hormone, growth hormone, luteinizing hormone, prolactin and thyroid stimulating hormone were examined. Four of the adenomas were reactive for prolactin; one was reactive for growth hormone, with scattered positivity for adrenocorticotropic hormone, follicle stimulating hormone, luteinizing hormone and thyroid stimulating hormone; 4 were nonreactive.

Adenoma↗

Diagnosis of inborn errors of metabolism from blood spots by acylcarnitines and amino acids profiling using automated electrospray tandem mass spectrometry.

Acylcarnitine profiling from blood or plasma samples by electrospray tandem mass spectrometry (ESI-MS/MS) has been recognized recently as a useful tool in the biochemical diagnosis of propionic acidemia, methylmalonic acidemia together with short-chain and medium-chain acyl-CoA dehydrogenase deficiencies. In the current study, we have investigated the diagnostic capabilities of ESI-MS/MS in other types of organic acidemias and amino acid catabolism disorders. Using multiple scanning functions, we examined the potential for the simultaneous profiling of both acylcarnitines and amino acids, in each of the samples. Our method was found to be specific and accurate; allowing quantification of acylcarnitines and amino acids well below, and significantly above, published normal levels. Complete automation of sample introduction has been achieved, allowing the analysis of up to 200 samples in one injection sequence, at a rate of one sample every 3 min, with excellent separation between successive injections. In our hands, this method permits screening for 20 organic acid and amino acid disorders, using a single sample injection. In our laboratory, more than 2000 blood samples have been analyzed, and 52 new cases were diagnosed by this method. We also confirmed the diagnosis of another 75 previously known cases.

Acetylcarnitine↗

Cisplatin and 5-fluorouracil for metastatic squamous cell carcinoma from unknown primary.

Chemotherapy for squamous cell carcinoma with unknown primary (SCUP) has not been prospectively studied. To evaluate the efficacy of cis-diaminedichloroplatinum (cisplatin) and 5-fluorouracil (5-FU) in advanced SCUP, we treated 15 patients with measurable disease. A prospective trial was conducted of cisplatin and 5-FU in patients presenting with SCUP. All patients had evaluation in search for primary disease with computed tomographic scan of the head, neck, and chest and endoscopic evaluation of the nasopharynx, larynx, esophagus, and tracheobronchial passages with negative blind biopsies. Chemotherapy consisted of cisplatin 100 mg/m2 on day 1 and 5-FU 1000 mg/m2 continuous infusion over 24 hr for 4 days. The regimen was repeated every 21 days. Responses were seen in 8 of 15 patients [1 complete response (CR) and 7 partial responses (PR)], for an overall response rate of 53%. These results suggest that cisplatin-5-FU combination has efficacy in advanced SCUP and deserves further trials both in advanced disease and in combined modality programs with surgery and radiation therapy.

Aged↗

Solubilization and characterization of diacylglycerol acyltransferase from microspore-derived cultures of oilseed rape.

Particulate fractions prepared from microspore-derived (MD) embryos of oilseed rape (Brassica napus L. cv. Reston) and an embryogenic MD cell suspension culture of oilseed rape (B. napus L. cv. Jet Neuf) were used as a source of diacylglycerol acyltransferase (DGAT, EC 2.3.1.20) for enzyme characterization and development of a solubilization procedure. DGAT activity in the 1500-100,000 g fraction from MD embryos was stimulated 4-5-fold by 3 to 4 mg of BSA/ml of reaction mixture. DGAT activity from MD embryos was stimulated 2-3-fold by fluoride salts and 1.4-fold by NaCl, whereas iodide salts caused substantial inhibition of enzyme activity. The effect of the various 1:1 electrolytes on enzyme activity appeared to be related more to their differential effects on solution structure rather than ionic strength. DGAT was solubilized from membranes of MD embryos and the cell suspension culture by about 80 and 50% respectively, using 2 M NaCl in 1% (w/v) octanoyl-N-methyl-glucamide (MEGA-8) (pH 8.0 buffer) at a detergent to protein ratio of 2:1. The specific activity of solubilized DGAT was about 2-fold greater than that of the particulate enzyme. The mechanism of solubilization appeared to be related to the lowering of the critical micellar concentration of MEGA-8 in the presence of NaCl. DGAT, solubilized from MD embryos, eluted with an M(r) of about 2 x 10(6) during gel-filtration chromatography on a Superose 6 column equilibrated in buffer containing 0.1% (w/v) MEGA-8. The solubilized enzyme exhibited optimal activity at pH 7. At concentrations above 2 microM acyl-CoA, the specificity of solubilized DGAT for oleoyl-CoA and palmitoyl-CoA was considerably greater than for stearoyl-CoA.

Acyltransferases↗

Postoperative immunological function and jaundice.

The effects of operative trauma and obstructive jaundice on systemic immunity were studied in a rat model, using the delayed-type hypersensitivity response to 2,4-dinitro-1-fluorobenzene as a measure of systemic immune responsiveness. Midline laparotomy caused a significant decrease in the mean(s.e.m.) delayed-type hypersensitivity response 1 week after operation (4.6(1.3) versus 19.0(2.2) per cent for controls). The response returned to control levels by 2 weeks (14.6(3.1) per cent). Common bile duct ligation and division resulted in a significantly depressed hypersensitivity response at 2 and 3 weeks (6.8(2.0) and 8.4(1.6) per cent respectively). The expected decrease in the response at 1 week in these animals was not observed (mean(s.e.m.) 12.7(2.7) per cent), suggesting a possible role for the normal liver in the induction of postoperative immune depression. Impaired function of the reticuloendothelial system was induced in non-jaundiced animals by Kupffer cell ablation following intraportal infusion of lambda-carrageenan. A similar prevention of postoperative immune hyporesponsiveness was observed (mean(s.e.m.) 10.4(1.0) versus 10.4(1.6) per cent for controls). Hepatic Kupffer cells play an important role in the induction of postoperative immune depression.

Animals↗

The power in our hands: integrating developmental care into neonatal transport.

Research has shown that infants who receive developmentally supportive care during the course of medical treatment in the NICU have improved long-term developmental outcomes. Developmentally sound interventions should be implemented as early as possible in the hospital course and can be incorporated successfully into the care provided during transport of sick neonates. If developmental interventions are planned and implemented thoughtfully and consistently throughout the transport course, it may be possible to reduce or prevent neurodevelopmental complications.

Child Development↗

The champions.

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Community Participation↗

Perioperative immune modulation.

BACKGROUND: The effects of operative trauma on systemic immunity were studied. The relative effects of skin incision and of breaching the peritoneum were determined. In addition, the role of the antiendotoxic agent taurolidine in preventing postoperative immune suppression was assessed. METHODS: Systemic immune responsiveness was measured as the delayed-type hypersensitivity (DTH) response to 2-4 dinitro l-fluorobenzene (DNFB) with an in vivo rat model. The effect of both laparotomy and taurolidine on the hepatic Kupffer cell population was determined by immunohistochemistry. RESULTS: This study confirmed that cellular immunity is significantly depressed after laparotomy (15.5%; range, 2.5%-24.0%) compared with unoperated controls (26.77%; range, 9.2%-38.0%). Opening the peritoneum appeared to be a critical factor in inducing this immunosuppression, in which animals undergoing a similar midline incision without opening of the peritoneum displayed minimal alteration in their DTH response (20.5%; range, 0.85%-41.5%). In addition, intraperitoneal administration of taurolidine in the perioperative period prevented this decrease in postoperative DTH response. Kupffer cell numbers were increased after intraperitoneal administration of taurolidine, compared with animals treated with intraperitoneal saline solution or unoperated controls. CONCLUSIONS: These findings confirm the presence of an operatively induced decrease in immune responsiveness and suggest that entering the peritoneum is an important factor in the induction of this effect. In addition, administration of taurolidine acts to prevent the impact of laparotomy on DTH response, possibly by preventing perioperative portal endotoxemia.

Animals↗