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Biomedical subjects

G M Clark

Publications and source records attributed to G M Clark.

At least 397 records · Page 22Linked to original sources

Alteration of EGF-receptor binding in human breast cancer cells by antineoplastic agents.

Polypeptide growth factors bind to membrane receptors on human breast cancer cells and stimulate cell proliferation, suggesting that they may be important in growth regulation. Inhibition of the stimulatory effects of these factors might result in antineoplastic activity. Since cytotoxic drugs have been shown to alter cell membrane characteristics, we have examined the effects of a variety of antitumor drugs on the binding of epidermal growth factor (EGF) to the membrane receptor of human breast cancer cells. Twenty-four standard or investigational cytotoxic drugs were screened at a concentration of one-tenth the achievable peak plasma level for their ability to inhibit binding of 125I-EGF to its receptor in MCF-7 human breast cancer cells. Although at this concentration statistically significant inhibition of binding was observed with 11 drugs, the maximum inhibition observed was only 27%. Five agents, representing classes of drugs with different modes of action, were then studied in more detail. Of these, preincubation with 5-fluorouracil, 4-hydroperoxy-cylophosphamide and doxorubicin inhibited MCF-7 colony formation in a dose-dependent manner, but these drugs had no effect on EGF-binding even at a concentration of 10 times the peak plasma level. Preincubation of cells with vinblastine and cisplatin, however, resulted in both reduced colony survival and a parallel reduction in EGF receptor binding. Membrane integrity, as measured by trypan blue exclusion, was not altered. Scatchard analysis of EGF binding demonstrated that the major effect of cisplatin was a reduction in binding affinity. We conclude that cisplatin and vinblastine at high concentrations can inhibit the binding of EGF to human breast cancer cells offering an additional possible mechanism for their antiproliferative activity.

Antineoplastic Agents↗

Surgical anatomy of the round window with special reference to cochlear implantation.

When the multi-channel cochlear implant electrode is inserted into the scala tympani through the round window the operation is best performed via a posterior tympanotomy. The view of the round window membrane, however, is incomplete because of its orientation and the fact that it has a conical shape. Nevertheless, a good view along the basal turn is obtained after the antero-inferior overhang of the round window niche and the crista fenestrae have been removed. It might be damaging to drill away the postero-superior overhang as the osseous spiral lamina lies extremely close to the round window membrane.

Animals↗

Sex hormone binding globulin and risk factors for breast cancer in a population of normal women who had never used exogenous sex hormones.

Sex hormone binding globulin (SHBG) concentrations were measured by immunoradiometric assay in serum samples from 1,221 healthy female volunteers aged 34-79 who had never used oral contraceptives or hormone replacement therapy, had no history of thyroid disease or cancer, and had not used any drugs known to influence SHBG in the 14 days preceding blood sampling. There were 616 premenopausal and 605 naturally postmenopausal women. In both premenopausal and postmenopausal women, SHBG decreased with increasing weight (Quetelt's Index) and was lower in single nulliparous women than in married nulliparous women or parous women. In premenopausal women, SHBG was higher in women with late menarche, was higher in smokers than in non-smokers, and was higher in blood samples taken during the first 12 days of the luteal phase than during the rest of the menstrual cycle. In postmenopausal women, SHBG increased with years since the menopause. The possible biological importance of these findings is discussed with particular reference to risk factors for breast cancer.

Adult↗

Vowel and consonant recognition of cochlear implant patients using formant-estimating speech processors.

Vowel and consonant confusion matrices were collected in the hearing alone (H), lipreading alone (L), and hearing plus lipreading (HL) conditions for 28 patients participating in the clinical trial of the multiple-channel cochlear implant. All patients were profound-to-totally deaf and "hearing" refers to the presentation of auditory information via the implant. The average scores were 49% for vowels and 37% for consonants in the H condition and the HL scores were significantly higher than the L scores. Information transmission and multidimensional scaling analyses showed that different speech features were conveyed at different levels in the H and L conditions. In the HL condition, the visual and auditory signals provided independent information sources for each feature. For vowels, the auditory signal was the major source of duration information, while the visual signal was the major source of first and second formant frequency information. The implant provided information about the amplitude envelope of the speech and the estimated frequency of the main spectral peak between 800 and 4000 Hz, which was useful for consonant recognition. A speech processor that coded the estimated frequency and amplitude of an additional peak between 300 and 1000 Hz was shown to increase the vowel and consonant recognition in the H condition by improving the transmission of first formant and voicing information.

Cochlear Implants↗

Acoustic parameters measured by a formant-estimating speech processor for a multiple-channel cochlear implant.

In order to assess the limitations imposed on a cochlear implant system by a wearable speech processor, the parameters extracted from a set of 11 vowels and 24 consonants were examined. An estimate of the fundamental frequency EF 0 was derived from the zero crossings of the low-pass filtered envelope of the waveform. Estimates of the first and second formant frequencies EF 1 and EF 2 were derived from the zero crossings of the waveform, which was filtered in the ranges 300-1000 and 800-4000 Hz. Estimates of the formant amplitudes EA 1 and EA 2 were derived by peak detectors operating on the outputs of the same filters. For vowels, these parameters corresponded well to the first and second formants and gave sufficient information to identify each vowel. For consonants, the relative levels and onset times of EA 1 and EA 2 and the EF 0 values gave cues to voicing. The variation in time of EA 1, EA 2, EF 1, and EF 2 gave cues to the manner of articulation. Cues to the place of articulation were given by EF 1 and EF 2. When pink noise was added, the parameters were gradually degraded as the signal-to-noise ratio decreased. Consonants were affected more than vowels, and EF 2 was affected more than EF 1. Results for three good patients using a speech processor that coded EF 0 as an electric pulse rate, EF 1 and EF 2 as electrode positions, and EA 1 and EA 2 as electric current levels confirmed that the parameters were useful for recognition of vowels and consonants. Average scores were 76% for recognition of 11 vowels and 71% for 12 consonants in the hearing-alone condition. The error rates were 4% for voicing, 12% for manner, and 25% for place.

Cochlear Implants↗

Psychophysical studies relevant to the design of a digital electrotactile speech processor.

Psychophysical tests were carried out to investigate the perception of electrocutaneous stimuli delivered to the digital nerve bundles. The tests provided data for defining the operating range of a tactile aid for patients with profound-to-total hearing loss, as well as the individual differences between subjects and the information that could be transmitted. Monopolar biphasic constant current pulses with variable pulse widths were used. Threshold pulse widths varied widely between subjects and between fingers for the same subject. Thresholds were reasonably stable, but maximum comfortable levels increased with time. Perceived intensity was weakly dependent on pulse rate. Absolute identification of stimuli differing in pulse width gave information transmissions from 1.3-2.1 bits, limited by the dynamic ranges of the stimuli (3-17 dB). Stimuli from electrodes placed on either side of each finger were identified easily by all subjects. Absolute identification of stimuli differing in pulse rate gave information transmissions from 0.5-2.0 bits. Difference limens for pulse rate varied between subjects and were generally poor above 100 pps. On the basis of the results, an electrotactile speech processor is proposed, which codes the speech amplitude as pulse width, the fundamental frequency as pulse rate, and the second formant frequency as electrode position. Variable performances on tasks relying on amplitude and fundamental frequency cues are expected to arise from the intersubject differences in dynamic range and pulse rate discrimination. The psychophysical results for electrotactile stimulation are compared with previously published results for electroauditory stimulation with a multiple-channel cochlear implant.

Communication Devices for People with Disabilities↗

Survival from first recurrence: relative importance of prognostic factors in 1,015 breast cancer patients.

Univariate and multivariate analyses of potential prognostic factors for 1,015 women with recurrent breast cancer confirmed that the site of initial recurrence is an important determinant for predicting survival from the time of initial recurrence. However, both estrogen receptor (ER) status and axillary lymph node status at diagnosis, as well as the length of the disease-free interval, provide additional independent information for predicting patient survival after disease recurrence. Involved axillary lymph nodes at the time of initial diagnosis and/or lack of ERs may indicate a highly malignant tumor or a weak host defense, either of which might be related to short survival after relapse. Patients with ER-negative tumors recurred more often in visceral and soft-tissue sites, while patients with ER-positive tumors were more likely to recur in bony sites. However, for each metastatic site, receptor-positive patients had longer survival

Adult↗

The University of Melbourne--nucleus multi-electrode cochlear implant.

To summarize, our preliminary results indicate that some prelingually deaf patients may get worthwhile help from a multiple-electrode cochlear implant which extracts formants. They can understand words and running speech better when using the cochlear implant with lip-reading compared to lip-reading alone. It has been encouraging that these improvements can occur in young adults and teenagers. It has also been encouraging that some can recognize place pitch as well as rate pitch. There are, however, considerable variations in performance and this may be due to the following factors: whether they have had some hearing after birth, the method of education used, the motivation of the patient and age at implantation. In conclusion it is important to emphasize that deaf children are severely disadvantaged however good their teacher of the deaf. Research on cochlear implants offers hope for profoundly-totally deaf children. These developments will not replace the caring, competent educators but complement their skills. There is also a greater need than ever for an interdisciplinary approach to these children.

Animals↗

CFU-GEMM correlate with neutrophil and platelet recovery in patients receiving autologous marrow transplantation after high-dose melphalan chemotherapy.

CFU-GEMM, multipotent progenitor cells, give rise to erythroid, granulocyte-macrophage and megakaryocytic cells. We have examined the utility of this assay for predicting hematologic recovery in patients treated with high-dose chemotherapy and autologous marrow rescue with cryopreserved marrow. In marrow samples from 50 patients CFU-E, BFU-E and CFU-GEMM significantly decreased following cryopreservation. The median value for CFU-E declined from 132,659 to 10,648, BFU-E decreased from 36,112 to 3345 and CFU-GEMM decreased from 3242 to 260 colonies per ml of marrow frozen. Once cryopreserved, the number of CFU-E, BFU-E and CFU-GEMM remained stable with prolonged storage in liquid nitrogen. In 48 patients uniformly treated with high-dose melphalan (180 mg/m2) and rescued with cryopreserved autologous marrow, univariate analyses showed that the time to platelet recovery (greater than 50 x 10(9)/l) was correlated with the number of CFU-E, BFU-E and CFU-GEMM infused (p less than 0.05). The time to neutrophil recovery was only correlated with the number of BFU-E and CFU-GEMM infused (p less than 0.01). However, by multivariate analyses, only the number of CFU-GEMM, and not CFU-E and BFU-E, infused correlated both with the time to neutrophil and platelet recovery. These data indicate that the CFU-GEMM assay may be useful for determining the repopulating ability of cryopreserved bone marrow.

Bone Marrow↗

Recent developments with the nucleus 22-electrode cochlear implant: a new two formant speech coding strategy and its performance in background noise.

A clinical evaluation of speech processing strategies for the Nucleus 22-electrode cochlear implant showed improvements in understanding speech using the new FOF1F2 speech coding strategy instead of the F0F2 strategy. Significant improvement in closed-set speech recognition in the presence of background noise was an additional advantage of the new speech processing strategy.

Cochlear Implants↗

Cardiotoxicity in patients treated with mitoxantrone: Southwest Oncology Group phase II studies.

A model describing the development of cardiotoxicity as a function of cumulative dose of a drug and other covariates is presented. Methods are given for testing and illustrating a cumulative dose effect. Also, equations for estimation of the probability of developing cardiotoxicity in the presence or absence of competing risks are given. The methods are illustrated for mitoxantrone by means of data obtained from Southwest Oncology Group studies.

Dose-Response Relationship, Drug↗

Preliminary results for the cochlear corporation multielectrode intracochlear implant in six prelingually deaf patients.

The preliminary results from this study indicate that some prelingually deaf patients may get worthwhile help from a multiple-electrode cochlear implant that uses a formant-based speech processing strategy. It is encouraging that these improvements can occur in young adults and teenagers. The results for two children are also encouraging. A 10-year-old child obtained significant improvement on some speech perception tests. It was easy to set thresholds and comfortable listening levels on a 5-year-old child, and he is now a regular user of the device. There are, however, considerable variations in performance among the prelingual patients, which may be related to the following factors: whether they have had some hearing after birth, the method of education used, the motivation of the patient, and age at implantation.

Adolescent↗

Binding of oestradiol to blood proteins and aetiology of breast cancer.

A prospective study of 5,000 women has shown that, compared to controls, those who subsequently developed breast cancer had a higher proportion of their blood oestradiol in the non-protein-bound and albumin-bound fractions (the bio-available fraction) and a lower proportion in the sex-hormone-bound fraction. The increased proportion of bio-available oestradiol was partly due to a lower concentration of sex-hormone-binding globulin. Weight was excluded as a confounding factor.

Adult↗

Simultaneous in vitro drug sensitivity testing on tumors from different sites in the same patient.

A human tumor cloning assay was used to analyze drug sensitivity profiles for 99 pairs of tumor samples taken simultaneously from the same patient. These pairs included two areas of the same primary (12 pairs), primary tumor versus metastasis (29 pairs), and metastasis versus metastasis (45 pairs). In addition, to assess variability in the culture and sensitivity techniques, 13 specimens were divided equally and processed twice. One hundred fourteen evaluable drug sensitivity tests were performed on the specimen pairs. Drug sensitivity profiles for the same specimen processed twice demonstrated good agreement (P = 0.03). Sensitivity profiles from two different areas of the same primary were also quite similar (P = 0.002). However, when one sampled a primary tumor and its metastasis for drug sensitivity testing, the agreement (in terms of percent survival) was poor (P = 0.84). Agreement was also poor for drug sensitivity profiles of one metastasis versus another metastasis (P = 0.39). This heterogeneity in drug sensitivity profiles of primary versus metastasis and of metastasis versus metastasis could account for some of the false positives and false negatives noted in clinical correlation trials with the cloning assay. It may also have implications for adjuvant treatment programs where chemosensitivity of the primary tumor can be determined, but will probably not be predictive for chemosensitivity of the micrometastases.

Antineoplastic Agents↗

Speech recognition for 40 patients receiving multichannel cochlear implants.

We collected data on 40 patients who received the Nucleus multichannel cochlear implant. Results were reviewed to determine if the coding strategy is effective in transmitting the intended speech features and to assess patient benefit in terms of communication skills. All patients demonstrated significant improvement over preoperative results with a hearing aid for both lipreading enhancement and speech recognition without lipreading. Of the patients, 50% demonstrated ability to understand connected discourse with auditory input only. For the 23 patients who were tested 12 months postoperatively, there was substantial improvement in open-set speech recognition.

Adult↗

Effect of exchange transfusion with Fluosol DA 20% on splenic distribution and immunocompetence of rat lymphocytes.

T- and B-splenic lymphocyte frequency, immune response 4 days after immunization with sheep red blood cells (SRBC), and proliferative response to concanavalin A (Con A) were determined 1, 3, and 5 days after exchange transfusion with Fluosol DA 20% (FDA) in adult, male Sprague-Dawley rats vs sham transfused rats. T-cell, T-helper, T-suppressor, and B-lymphocyte were reduced 1 day after transfusion (P less than or equal to 0.001). T- and B-lymphocyte frequencies were still reduced at day 3 (P = 0.0372). By day 5, there were no significant reductions in T-cell, T-helper, T-suppressor, and B-cell frequencies in the FDA-transfused rats. The frequency of cells with cytoplasmic IgG was reduced (P less than or equal to 0.025) in cells harvested from spleens of FDA-transfused rats and tested fresh. Proliferative response of splenic lymphocytes to Con A was unaffected by transfusion with FDA (P greater than or equal to 0.078). Splenic hemolytic plaques in response to SRBC were unaffected if rats were transfused 3 days after immunization with SRBC and 1 day prior to study (P = 0.941), enhanced if rats were transfused 1 day after SRBC immunization and 3 days prior to study (P = 0.0015), and suppressed if rats were transfused 1 day before SRBC immunization and 5 days before study (P less than 0.0001). Transfusion with FDA causes transient decreases in identifiable T and B lymphocytes, depresses cytoplasmic IgG-positive B cells, does not affect proliferative response to Con A, does not affect an ongoing specific immune response, enhances an early specific immune response, and inhibits the induction of a specific immune response.

Animals↗