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Biomedical subjects

K J Myers

Publications and source records attributed to K J Myers.

At least 19 recordsLinked to original sources

Synergy between encephalitogenic T cells and myelin basic protein-specific antibodies in the induction of experimental autoimmune encephalomyelitis.

Experimental autoimmune encephalomyelitis (EAE) is an experimentally induced demyelinating disease mediated by CD4+ T cells specific for various myelin proteins including myelin basic protein (MBP) and myelin proteolipid protein (PLP). Although myelin- and other CNS-specific antibodies are produced in EAE, B cells and antibodies are thought by most not to play a decisive role in the induction of EAE. In this report we show that B cells serve as the major antigen-presenting cells (APC) during the T cell activation stage in lymph nodes, and that MBP-specific antibodies can greatly enhance the induction of EAE. The role of B cells as APC is demonstrated in B cell-depleted mice. EAE cannot be induced by antigen/complete Freund's adjuvant immunization unless these mice are locally reconstituted with B cells prior to immunization. The enhancing effect of antibodies is demonstrated in experiments in which EAE is induced by the adoptive transfer of encephalitogenic T cells. The adoptive transfer of large numbers of encephalitogenic T cells induces EAE in 90% of normal recipient mice, but only 33% of B cell-depleted mice get EAE at the same cell dose. The efficiency of EAE induction in B cell-depleted mice can be enhanced if MBP-specific antibodies are simultaneously administered. A similar enhancement is also seen in normal mice when the number of adoptively transferred T cells is limiting. We propose that MBP-specific antibodies enhance the presentation of myelin-derived antigens by APC in the CNS to the adoptively transferred encephalitogenic T cells.

Animals

Optometry research. Part 1: Funding sources.

Part 1 of this report presents an overview of U.S. ophthalmic research in general and of optometry research in particular and identifies the National Eye Institute (NEI) as the dominant funder of both types of research. Part 2 examines how NEI funding has been distributed among the U.S. schools and colleges of optometry in the past, whereas Part 3 examines the production of published research from the schools and colleges and the Department of Veterans Affairs Optometry Service. Information is presented to indicate that the schools of optometry account for about 3% of all NEI funding and produce about 3% of all published ophthalmic research. Published optometry research results mainly from the activities of four schools and the VA Optometry Service, which has rapidly become the leading source of articles published in The Journal of the American Optometric Association and presenter of continuing education at the Academy's annual Ellerbrock Lectures. This study suggests optometry needs to husband its relatively small research base and, in the author's opinion, concentrate on the support of clinical trials and research directly relevant to primary eye care rather than basic biologic or physiologic research.

Humans

Emergency medical operations at Kennedy Space Center in support of space shuttle.

The unique environment of the Kennedy Space Center includes a wide variety of industrial processes culminating in launch and spaceflight. Many are potentially hazardous to the work force and the astronauts. Technology, planning, training, and quality control are utilized to prevent contingencies and expedite response should a contingency occur.

Aerospace Medicine

Pharmacokinetics of sufentanil in obese patients.

The pharmacokinetics of sufentanil were determined in eight obese (94.1 +/- 14 kg, mean +/- SD) and eight control patients (70.1 +/- 13 kg) anesthetized for neurosurgery. After induction of anesthesia, 4 micrograms/kg of sufentanil was administered in a single intravenous bolus. Multiple arterial samples were obtained at timed intervals over 6 h, and plasma concentrations of sufentanil were measured by radioimmunoassay. Calculation of pharmacokinetic variables from the derived compartmental models demonstrated an increased volume of distribution of sufentanil in the obese (9098 +/- 2793 mL/kg ideal body weight, mean +/- SD) when compared with a control group (5073 +/- 1673 mL/kg ideal body weight) (P less than 0.01) and a prolonged elimination half-life (208 +/- 82 min vs 135 +/- 42 min, P less than 0.05). The total volume of distribution correlated linearly with the degree of obesity, as expressed in percent ideal body weight (r = 0.67). In contrast, plasma clearance was similar in both obese and control groups (32.9 +/- 12.5 vs 26.4 +/- 5.7 mL/kg ideal body weight). The high lipid solubility of sufentanil probably explains the altered pharmacokinetics of this opioid in obese patients.

Adult

Alcohol as a nutrient: interactions between ethanol and carbohydrate.

This study examined metabolic interactions between two nutrients--ethanol and carbohydrate. Both nutrients are metabolized by a common pathway to fatty acids from acetyl-coenzyme A by lipogenic enzymes. The effects of ethanol and carbohydrate on the induction of lipogenic enzymes in livers of rats were examined using two types of base diets differing in carbohydrate and lipid content and using isocaloric substitutions of ethanol, carbohydrate, and fat. Three nonlipogenic enzymes were used for comparison. Isocaloric substitution of both fat and carbohydrate for ethanol was necessary to show the specific effects of alcohol on the activity of lipogenic or nonlipogenic enzymes. Carbohydrate, and not ethanol, induced lipogenic enzymes. Ethanol specifically reduced the activity of lactate dehydrogenase and malic enzyme, but did not affect those of alcohol dehydrogenase or glycerol 3-phosphate dehydrogenase. Ethanol interacted with carbohydrate to increase the activity of ATP citrate lyase. In addition, we studied the effects of ethanol and different kinds of carbohydrates on the growth of rats and on the morphology of their livers and intestines. Ethanol significantly decreased growth characteristics (weight gain, growth rate, and caloric efficiency). Fructose, either as a monosaccharide or in sucrose, decreased this alcohol effect. Sucrose was better than glucose in lowering lipid accumulation in livers of rats. Fragility of intestinal villi was found with an alcohol, low carbohydrate diet, but was not present in alcohol diets with a higher level of carbohydrate. In contrast to carbohydrate, ethanol lacked some characteristics of a nutrient, namely, it did not induce some enzymes involved in its metabolism and did not promote optimum growth.

Animals

Aperture optimization for emission imaging: effect of a spatially varying background.

A method for optimizing the aperture size in emission imaging is presented that takes into account limitations due to the Poisson nature of the detected radiation stream as well as the conspicuity limitation imposed by a spatially varying background. System assessment is based on the calculated performance of two model observers: the best linear observer, also called the Hotelling observer, and the nonprewhitening matched-filter observer. The tasks are the detection of a Gaussian signal and the discrimination of a single from a double Gaussian signal. When the background is specified, detection is optimized by enlarging the aperture; an inhomogeneous background results in an optimum aperture size matched naturally to the signal. The discrimination task has a finite optimum aperture for a flat background; a nonuniform background drives the optimum toward still-finer resolution.

Image Processing, Computer-Assisted

How reliable is the Goldmann tonometer as a standard?

In a clinical comparison of an XPERT NCT non-contact tonometer with Goldmann applanation tonometry (GAT), reported in the companion article, we concluded that the XPERT is a highly accurate and reliable instrument. By design, our evaluation differed significantly from earlier clinical studies in its use of multiple references (four calibrated GAT reference tonometers and seven GAT operators). Five clinicians were responsible for GAT measurement of 400 of a 620 eye population. Each clinician's population sample was essentially drawn at random from the common pool. XPERT vs. GAT performance indices were calculated for each of the five GAT operators. Because XPERT's measurements are essentially free of operator influence, it is reasonable to conclude that differences found among these five "XPERT performance" findings were primarily attributable to differences in GAT operator technique and endpoint judgment. Our findings disclose compelling evidence that GAT's accuracy and reliability depends on individual operator technique and experience. They indicate that in a clinical comparison, the protocol safeguards proposed by Wittenberg need be applied to ensure the integrity of studies using GAT as the reference tonometer.

Humans

XPERT NCT--a clinical evaluation.

A clinical evaluation of the XPERT NCT (Reichert Ophthalmic Instruments) applanation non-contact tonometer was conducted at the Baltimore VA Medical Center. Each of 620 eyes were measured by the XPERT and then by one of seven operators of varied experience, each using one of four calibrated Goldmann applanation tonometers (GATs). Measured pressures ranged from 1 to more than 60 mmHg. The interval between XPERT and GAT measurements varied from a few minutes to almost 1 hour. Despite the increased potential variability of our protocol, the XPERT agreed very closely with GAT. Population IOP means agreed within 0.3 mmHg; regression coefficients defining XPERT's calibration, relative to GAT, were slope (m) = 1.025, and Y intercept (b) = 0.7 mmHg. The standard deviation of matched pair differences, was Sd = 2.7 mmHg. We conclude that the XPERT NCT is a highly accurate and reliable instrument. Our experience showed it to be convenient and well accepted by staff and patients. It proved faster, easier to use, and its "air-puff" is quieter and less intense than NCT I and II. In the companion paper, we examined the reliability of GAT used as a clinical comparison reference in evaluating the XPERT.

Evaluation Studies as Topic

Comparison of in vivo scintillation probes and gamma cameras for detection of small, deep tumours.

An in vivo probe was compared with a gamma camera for the task of detecting radiolabelled tumour models in a water phantom. The probe, which contained a 1 cm diameter NaI(T1) detector, was designed and used by us for surgical staging studies of gynaecological patients. Tumours were spherical sources of different sizes and activities per unit volume of cobalt-57. The phantom was a tank of water (451) containing dissolved radioactivity to simulate background activity. Detector-to-source separations and tank depths were also varied. Camera images of 10 min duration were compared with probe counts of 15 s. For each configuration a large number of source and background runs were analysed using an ideal-observer ROC technique. Area under the ROC curve was used as the figure of merit. Results show that for approximately uniform background the probe should perform substantially better than the gamma camera in detecting small, deep tumours provided that the probe can be manoeuvred to within a few centimetres of the tumour. Mathematical modelling of our results indicates that this conclusion is not dependent on radiopharmaceutical dose, tumour uptake or camera type.

Cobalt Radioisotopes

Central retinal vein occlusion and iris neovascularization hemorrhage.

Although there have been few direct observations, the etiology of spontaneous hyphema in patients with retinal or ocular hypoxia is assumed to be hemorrhage from a neovascular iris vessel. This paper reports observed hemorrhage from such a rubeotic iris in a patient with central retinal vein occlusion, diabetes, hypertension, peripheral vascular disease and chronic open-angle glaucoma. Bleeding was spontaneous with dilation, but stopped within 24 hours without treatment, leaving only traces of inferior angle blood staining. The two types of central retinal vein occlusion, and suggestions for their management, are also discussed.

Humans

Hospitals and optometry: an evolving relationship.

Most hospital-based optometrists practice at government hospitals or HMOs that provide comprehensive care. But most U.S. hospitals are private, provide episodic acute care, and limit admitting, staff and clinical privileges to physicians. Most patients that private optometrists treat do not require hospital admission, but many do require laboratory tests or procedures (ultrasonography, radiographic studies, CAT and NMR studies, clinical laboratory blood/serology studies and glucose tolerance tests) that can be provided by hospitals. Hospital admitting, staff, or clinical privileges are not needed for optometrists to order these studies for their patients on an outpatient basis. This type of hospital affiliation may initially be more useful to more optometrists than staff membership, admitting, or clinical privileges and would improve patient care and quality of referrals. This paper reviews hospital organization, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) Standards and how they apply to optometrists wishing to affiliate with private hospitals.

Aged

Hotelling trace criterion and its correlation with human-observer performance.

The Hotelling trace criterion (HTC) is used to find a set of linear features that optimally separate two classes of objects. The objects used in our study were simulated livers with and without tumors, with noise, blur, and object variability. Using the receiver-operating-characteristic parameter da as our measure, we have found that the ability of the HTC to separate these objects into their correct classes, by detecting the presence or absence of a tumor, has a correlation of 0.988 with the ability of humans to separate the same two classes of objects. This suggests, therefore, that the HTC can be used as a figure of merit for optimizing system parameters, since it calculates a single, scalar figure of merit that has a high correlation with human-observer performance.

Humans

Addition of a channel mechanism to the ideal-observer model.

Several authors have measured the detection ability of human observers for objects in correlated (nonwhite) noise. These studies have shown that the human observer has approximately constant efficiency when compared with a nonprewhitening ideal observer. In this paper we add a frequency-selective mechanism to the ideal-observer model, similar to the channel mechanism that has been demonstrated through experiments that measure a subject's ability to detect grating stimuli. For a number of detection and discrimination tasks, the nonprewhitening ideal-observer model and the channelized ideal-observer model yield similar performance predictions. Thus both models seem equally capable of explaining a considerable body of psychophysical data, and it would be difficult to devise an experiment to determine which model is more nearly correct.

Humans

VA residencies.

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Hospitals, Veterans

Effect of noise correlation on detectability of disk signals in medical imaging.

Pixel signal-to-noise ratio is one accepted measure of image quality for predicting observer performance in medical imaging. We have found, however, that images with equal pixel signal-to-noise ratio (SNRp) but different correlation properties give quite different observer-performance measures for a simple detection experiment. The SNR at the output of an ideal detector with the ability to prewhiten the noise is also a poor predictor of human performance for disk signals in high-pass noise. We have found constant observer efficiencies for humans relative to the performance of a nonprewhitening detector for this task.

Fourier Analysis