Vein graft disease:avoiding problems.
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Graft Occlusion, Vascular↗
Biomedical subjects
K Kent
Publications and source records attributed to K Kent.
Perturbed bioelectrical properties of the mouse cecum following hepatectomy and starvation: the role of bacterial adherence.
Previous work in our laboratory has demonstrated that bacterial adherence alone to the intestinal epithelium, as occurs following catabolic stress, significantly perturbs the normal electrophysiology of the cecal mucosa. The aim of this study was to further characterize these effects in the mouse cecum following hepatectomy and short-term starvation, and to define the role of bacterial adherence in this process. Groups of mice underwent a surgical hepatectomy and were either fed or starved during the postoperative period. Groups of controls underwent sham operations and were either fed or starved postoperatively. Electrophysiologic studies in Ussing chambers at 48 hours were performed. Bacterial adherence to the mucosa was assessed by culture and histologic staining. To determine the role of bacteria in the altered electrophysiologic response, ciprofloxacin decontamination studies were performed. Only mice subjected to both hepatectomy and starvation developed bacterial adherence of sufficient magnitude (>10(5) cfu/gm) to alter mucosal electrophysiology (short-circuit current and basal potential difference). Ciprofloxacin decontamination completely abrogated this effect. Ion replacement studies suggested that active sodium transport was primarily responsible for the observed changes in mucosal electrophysiology. Bacterial-epithelial cell interactions may be responsible for altered mucosal ion transport observed following operative catabolic stress and short-term starvation.
Animals↗
The appearance of escape variants in vivo does not account for the failure of recombinant envelope vaccines to protect against simian immunodeficiency virus.
The presence or evolution of immune escape variants has been proposed to account for the failure of recombinant envelope vaccines to protect macaques against challenge with simian immunodeficiency virus (SIVmac). To address this issue, two groups of three cynomolgus macaques were immunized with recombinant SIV Env vaccines using two different vaccine schedules. One group of macaques received four injections of recombinant SIV gp120 in SAF-1 containing threonyl muramyl dipeptide as adjuvant. A second group were primed twice with recombinant vaccinia virus expressing SIV gp160 and then boosted twice with recombinant SIV gp120. Both vaccine schedules elicited neutralizing antibodies to Env. However, on the day of challenge, titres of anti-Env antibodies measured by ELISA were higher in macaques primed with recombinant vaccinia virus. Following intravenous challenge with 10 monkey infectious doses of the SIVmac J5M challenge stock, five of the six immunized macaques and all four naive controls became infected. The virus burdens in PBMC of macaques that were primed with recombinant vaccinia virus were lower than those of naive controls, as determined by virus titration and quantitative DNA PCR. Sequence analysis was performed on SIV env amplified from the blood of immunized and naive infected macaques. No variation of SIV env sequence was observed, even in macaques with a reduced virus load, suggesting that the appearance of immune escape variants does not account for the incomplete protection observed. In addition, this study indicates that the measurement of serum neutralizing antibodies may not provide a useful correlate for protection elicited by recombinant envelope vaccines.
Amino Acid Sequence↗
Estradiol inhibits allograft-inducible major histocompatibility complex class II antigen expression and transplant arteriosclerosis in the absence of immunosuppression.
BACKGROUND: The etiology of transplant arteriosclerosis is unknown, but current data point to the alloimmune response. Previously, we found that estradiol-17beta (E2) with immunosuppressant cyclosporine abolishes major histocompatibility complex (MHC) class II expression in the allograft. This study determines the effect of E2 on MHC class II antigen expression in the allograft, in the absence of immunosuppression. METHODS: Lewis male rats received orthotopic abdominal aorta allografts from male Brown-Norway rats. The recipients were treated continuously subcutaneously with either 20 microg x kg(-1) x day1 of E2 (n=20) or placebo (n=20), from 2 days before transplantation until death on posttransplant days 1, 3, 7, and 14. The allografts were harvested and processed for morphometry and for immunohistochemical staining of MHC class II antigens, macrophages, CD4 and CD8 T lymphocytes, interferon-gamma (IFN-gamma), and IFN-gamma receptor. RESULTS: With E2 treatment, we observed that inducible MHC class II antigen expression is abolished in the media of the vascular allograft; the expression of IFN-gamma and IFN-gamma receptor is unaffected; and macrophage infiltration of the vascular allograft is inhibited significantly (P<0.01), whereas the CD4 and CD8 T lymphocytes are not significantly (P=0.07) suppressed. The myointimal hyperplasia in the allografts from E2-treated-recipients was 3-4-fold less than that from the placebo-treated recipients. CONCLUSIONS: Without immunosuppression, E2 inhibition of transplant arteriosclerosis is still associated with inhibition of inducible MHC class II antigen expression in the allografts. The estradiol-17beta abolition of inducible MHC class II antigen expression in the aorta allograft occurs in spite of up-regulation of IFN-gamma ligand and receptor protein.
Animals↗
Evaluation of a candidate human immunodeficiency virus type 1 (HIV-1) vaccine in macaques: effect of vaccination with HIV-1 gp120 on subsequent challenge with heterologous simian immunodeficiency virus-HIV-1 chimeric virus.
Human immunodeficiency virus type 1 (HIV-1) envelope vaccines can now be evaluated for efficacy in macaques by challenging with chimeric viruses in which the env, tat and rev genes of simian immunodeficiency virus (SIV) have been replaced by those of HIV-1. Most experiments have so far been conducted using gp120 molecules derived from T-cell-adapted LAI or MN strains of HIV-1, which predominantly use the CXCR-4 co-receptor. These vaccines protect against infection by apathogenic chimeric virus carrying the same envelope sequences. In the experiment described here, four macaques were vaccinated with W61D gp120 derived from a low passage Dutch isolate and capable of inhibiting the binding of MIP1beta to the co-receptor CCR-5. This vaccine was potent, inducing high titres of binding and neutralizing antibodies against the homologous HIV-1 and tenfold lower titres against a heterologous challenge virus (SHIV(SF33)) in which the env, tat and rev genes of SIV had been replaced by those of a San Francisco isolate, HIV-1(SF33). Despite strong immune responses to the vaccine there was no evidence that it protected against challenge with this chimeric virus. The antigenic divergence between vaccine and challenge virus or the increased virulence of the challenge virus may be responsible for the inability of this vaccine to protect against infection by SHIV(SF33).
AIDS Vaccines↗
Evasion of cytotoxic T lymphocyte (CTL) responses by nef-dependent induction of Fas ligand (CD95L) expression on simian immunodeficiency virus-infected cells.
Inoculation of macaques with live attenuated SIV strains has been shown to protect against subsequent challenge with wild-type SIV. The protective mechanism(s) remain obscure. To study the effect in more detail, we have investigated the role of virus-specific CTL responses in macaques infected with an attenuated SIV strain (pC8), which has a four-amino acid deletion in the nef gene, as compared with the wild-type SIVmac32H clone (pJ5). Cynomolgus macaques infected with pC8 were protected against subsequent challenge with pJ5 and did not develop any AIDS-like symptoms in the 12 months after infection. The pC8-induced protection was associated with high levels of virus-specific CTL responses to a variety of viral antigens. In contrast, pJ5-infected macaques had little, if any, detectable CTL response to the viral proteins after three months. The latter group of macaques also showed increased Fas expression and apoptotic cell death in both the CD4(+) and CD8(+) populations. In vitro, pJ5 but not pC8 leads to an increase in FasL expression on infected cells. Thus the expression of FasL may protect infected cells from CTL attack, killing viral-specific CTLs in the process, and providing a route for escaping the immune response, leading to the increased pathogenicity of pJ5. pC8, on the other hand does not induce FasL expression, allowing the development of a protective CTL response. Furthermore, interruption of the Fas-FasL interaction allows the regeneration of viral-specific CTL responses in pJ5-infected animals. This observation suggests an additional therapeutic approach to the treatment of AIDS.
Acquired Immunodeficiency Syndrome↗
Skeletal effects of cyclic recombinant human growth hormone and salmon calcitonin in osteopenic postmenopausal women.
The objectives of this study were to determine whether cyclic administration of recombinant human GH, with or without the antiresorptive agent, salmon calcitonin (CT), provides clinically meaningful increases in bone mineral density (BMD) at the lumbar spine and proximal femur in postmenopausal osteopenic women. The design of the study was a randomized clinical trial consisting of 12 56-day treatment cycles. Each cycle was initiated by a 12-day period of hormone administration, followed by 44 days of supplemental calcium only. Cycles of hormone administration consisted of 7 daily injections of recombinant GH (20 micrograms/kg.day) or its placebo, followed by 5 daily injections of salmon CT (100 U/day) or its placebo. The study was performed at the Palo Alto Veterans Affairs medical center. The patients were 84 healthy women with lumbar spine BMD more than 1 SD below the average value for a healthy 25-yr-old Caucasian woman. BMD was measured at the lumbar spine and proximal femur by dual energy x-ray absorptiometry. Biochemical markers of bone turnover and circulating insulin-like growth factor I were also measured. GH treatment increased insulin-like growth factor I concentrations from low values at baseline (112 +/- 56 ng/mL) to the young normal range (approximately 430 +/- 125 ng/mL). Groups receiving GH plus CT or GH plus placebo increased lumbar spine BMD at 2 yr by 2.70 +/- 0.81% (P < 0.01) and 1.72 +/- 0.74% (P < 0.05; intention to treat analysis). No significant change occurred in women receiving placebo plus CT or combined placebo. Significant increases in total hip BMD of 1-2% were observed for the GH plus placebo and placebo plus CT groups, with a nonsignificant trend in the GH plus CT group. For the femoral trochanter, significant increases were observed in the GH plus CT and placebo plus CT groups only. No significant change in femoral neck BMD was observed in any group. Women taking replacement estrogen had the same BMD response as those who were estrogen deficient. No significant increase in BMD was observed between 24 and 36 months in the 62 women who returned for a 3 yr measurement. In response to GH, short term increases in resorption and formation markers were observed, but these had decreased before the next treatment cycle. No long term changes in resorption markers were observed, but women in the GH groups showed a sustained rise in circulating osteocalcin over the entire 2-yr protocol. GH given cyclically with or without CT for 2 yr achieved statistically significant increases in BMD of the lumbar spine and selected areas of the hip in postmenopausal women. These gains were less marked than those achieved with estrogen or bisphosphonates and were associated with a relatively high incidence of adverse experiences. Therefore, it is unlikely that cyclic GH with or without CT will prove clinically useful in the treatment of postmenopausal women with osteoporosis.
Aged↗
Collaboration in research: testing the PIPC model on clinical and nonclinical outcomes.
This outcomes research used a collaborative framework between a college of nursing and a medical center to test the effects of the Partners in Patient Care delivery model (PIPC) on clinical and nonclinical outcomes. An experimental pretest-postest design was used to compare selected nonclinical outcomes and clinical outcomes of care in two patient units. Results showed that there were significant differences between units in the nonclinical outcomes of nurse satisfaction, salary costs, supply costs, and productivity as measured by documentation time. In addition, there were significant differences in the clinical outcomes of care in terms of patient satisfaction. No significant differences were found in number of falls, medication errors, and intravenous infections; however, when ratios of these indicators were examined in relation to patient days, significant differences in the medication error ratio and the fall ratio were revealed. The results indicate that the PIPC delivery model did have positive effects on patient satisfaction and nurse satisfaction but that there were increased costs and increased time spent in documentation on the pilot unit.
Clinical Nursing Research↗
Has improvement in PTCA intervention affected long-term prognosis? The NHLBI PTCA Registry experience.
BACKGROUND: The NHLBI Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry followed 1345 consecutive patients with first PTCA between 1977 and 1981 (registry 1) and 2136 consecutive patients with PTCA between 1985 and 1986 (registry 2). Changes in patient selection and in immediate and 1-year outcome are presented. This report extends to 5 years the comparison of the effects of early and more recent management with PTCA. METHODS AND RESULTS: Sixteen participating centers entered consecutive patients who had angioplasty for the first time between 1977 and 1981 and between 1985 and 1986. Patients with recent myocardial infarction (MI) were excluded. Vessel disease was defined according to the Coronary Artery Surgery Study. Successful dilatation required > or = 20% reduction in luminal narrowing and < 50% lumen diameter stenosis after intervention. Routine annual follow-up was conducted by telephone interview. The product-limit method was used to estimate freedom from untoward events, Cox regression analysis to model relative risk and adjusted relative risk of events between the two registries, and logistic regression when the exact time of outcome (such as recurrence of symptoms) was not known. Long-term event rates were computed by vessel disease for all patients and for the cohort of patients with initially successful PTCA. After adjustment for extent of disease, diabetes, prior bypass surgery (CABG), hypertension, age, and sex, the 5-year risk of death was similar in the two registry cohorts. However, rates of MI, CABG, and a combined outcome measure of death, MI, and/or CABG were significantly lower in the registry 2 cohort both for all patients and for patients who were initially treated successfully. Use of repeated PTCA was higher, and freedom from symptoms without adverse events was significantly better in the latter cohort. CONCLUSIONS: Compared with registry 1, the management of the registry 2 cohort resulted in lower 5-year morbid event rates and reduced CABG operations. Mortality rates remained similar. When symptomatic status was considered in combination with events, a significantly better outcome was seen overall and in the initially successful cohort. In registry 2, repeated PTCA was used with much greater frequency early after the initial procedure.
Angioplasty, Balloon, Coronary↗
Protection by attenuated simian immunodeficiency virus in macaques against challenge with virus-infected cells.
A vaccine against AIDS will probably have to protect against challenge both by viable virus-infected cells and by cell-free virus. Eight cynomolgus macaques infected with attenuated simian immunodeficiency virus (SIV) were challenged (four each) with cell-free and cell-associated SIV. All were protected, whereas eight controls were all infected after challenge. These findings show that live-attenuated vaccine can confer protection against SIV in macaques. Extrapolation to human beings will require extensive evaluation of the safety of attenuated retroviruses. Alternatively, the mechanism of this potent protection must be understood and reproduced by less hazardous means.
AIDS Vaccines↗
Development of latent fingerprints using preferential DC sputter deposition.
It was shown that a DC metal sputtering process with thermalised atoms, preferentially deposits metal onto fingerprint ridges. This method can be successfully used for the development of latent fingerprints. Four target metals were tested--copper, zinc, platinum, and gold--with platinum showing superior results for latent fingerprint development on clear polythene substrates. A comparison of platinum sputtering and cyanoacrylate fuming followed by rhodamine-6G staining, was conducted for 1-year-old fingerprint deposits. Platinum sputtering showed significantly higher sensitivity, and produced better overall results.
Copper↗
Team-building process in launching a practice model.
With the growing use of multiple types of nurse extenders in new patient care-delivery models, there is a need not only for outcome research on their design and use but for identification and discussion of effective team-building processes necessary to implementing these models. This article presents an analysis of the interdisciplinary team process and the levels of team building and processes needed at each level to test a new nursing practice model. The team processes included not only those within the medical center but included the collaborative process established between the college of nursing and medical center. Both of these were crucial to a successful change in nursing practice.
Group Processes↗
Immunization with class I human histocompatibility leukocyte antigen can protect macaques against challenge infection with SIVmac-32H.
OBJECTIVE: To evaluate the efficacy of immunopurified class I human histocompatibility leukocyte antigen (HLA) to protect against SIV infection. METHODS: HLA class I antigens were immunopurified from a human B-lymphoblastoid cell line. Groups of four macaques were vaccinated subcutaneously with four doses of the immunogen in adjuvant, or with adjuvant alone and subsequently challenged intravenously with 10 median monkey infectious doses of cell-free SIVmac-32H. Infection was determined by polymerase chain reaction for SIVmac proviral DNA and by virus isolation. Antigen-specific humoral and cellular immune responses were monitored. RESULTS: Macaques immunized with the HLA molecules produced anti-HLA class I antibodies that inhibited SIV replication in vitro and downregulated autologous T-cell proliferation against irradiated C8166 cells. They were partially protected (two out of four) from virus infection for at least 33 weeks when challenged with SIV grown in human cells. All four control animals were infected. CONCLUSIONS: This demonstration of partial protection, together with our previous work reporting that vaccination with allogenic cynomolgus lymphocytes can protect against challenge infection with SIV grown in simian cells, suggests that allogenic immune response induced before or during establishment of HIV infection may have important implications for AIDS disease progression.
Animals↗
Percutaneous excimer laser coronary angioplasty: results in the first consecutive 3,000 patients. The ELCA Investigators.
OBJECTIVES: We report the comprehensive results of the first consecutive 3,000 patients treated in an excimer laser coronary angioplasty registry. BACKGROUND: Excimer laser coronary angioplasty involves the use of a pulsed, 308-nm ultraviolet laser transmitted by optical fibers to reduce coronary stenoses. Preliminary reports have described safety and efficacy profiles in small numbers of patients. METHODS: Patients were enrolled in a prospective, nonrandomized manner. The catheters used were 1.3, 1.6, 2.0, 2.2 and 2.4 mm in diameter, at energy densities up to 70 mJ/mm2. Procedures were performed by standard angioplasty technique with conventional guide catheters. RESULTS: Seventy-five percent of patients were male, 68% were in Canadian Cardiovascular Society functional class III or IV and the cohort included 3,592 lesions. Procedural success (final stenosis < or = 50% without in-hospital Q wave myocardial infarction, coronary artery bypass surgery or death) was 90% and did not differ between the first 2,000 and the last 1,000 patients treated. There was no significant difference in success or complication rates with respect to lesion length, nor were there differences between selected complex and simple lesions. Complications included in-hospital bypass surgery (3.8%), Q wave myocardial infarction (2.1%) and death (0.5%). Coronary artery perforation occurred in 1.2% of patients (1% of lesions) but significantly decreased to 0.4% in the last 1,000 patients (0.3% of lesions). Angiographic dissection occurred in 13% of lesions, transient occlusion in 3.4% and sustained occlusion in 3.1%. Comprehensive lesion morphologic data collected in the latter portion of the study showed the procedure predominantly limited to American College of Cardiology-American Heart Association type B2 and C lesions, with no significant difference in short-term outcome between groups. CONCLUSIONS: Excimer laser angioplasty can be safely and effectively applied, even in a variety of complex lesions not well suited for percutaneous transluminal coronary angioplasty. These types may include aorto-ostial, long lesions, total occlusions crossable with a wire, diffuse disease and vein grafts. Most recent data show a trend for the selection of predominantly complex lesions and a reduction in the incidence of perforation. This procedure may broaden the therapeutic window for the interventional treatment of selected complex coronary artery disease.
Angioplasty, Balloon, Coronary↗
Fine analysis of humoral antibody response to envelope glycoprotein of SIV in infected and vaccinated macaques.
To characterize the serological response to SIV envelope, induced by vaccination with different envelope immunogens or by SIV infection, plasma samples from 11 cynomolgus macaques infected with simian immunodeficiency virus (SIV) and from 16 macaques vaccinated with three different recombinant envelope proteins were analyzed by (1) ELISA, using a variety of antigens including overlapping peptides encompassing the entire sequence of the envelope protein of SIV, and (2) competition assays, using neutralizing monoclonal antibodies to SIV gp120. Seven regions of SIV envelope were predicted to be antigenic. Peptides representing four of these, in the second and third variable regions (V2 and V3) and the fourth constant (C4) region of gp120 and the Gnann region of gp41, were recognized by the majority of sera from infected and vaccinated animals. Additional antigenic regions were identified in the first and fourth variable domains (V1 and V4) and the carboxy terminus (C5) of gp120 and in three additional regions of gp41. Most infected and vaccinated animals made antibodies that competed with the binding of the three conformational MAbs. Among the vaccinated groups, antibodies induced by vaccination with precursor glycoproteins (gp140 or gp160) recognized several additional gp120 epitopes when compared with antibodies induced by external glycoprotein gp130. Sera from infected animals showed a more restricted gp120 response (17 of 46 peptides recognized) compared to animals vaccinated with precursor glycoproteins (31 peptides recognized). The converse was true for antibodies to gp41. Sera from animals vaccinated with recombinant gp140, produced in insect cells, were the only group that failed to compete with the binding of conformational MAbs. Finally, the development of antibodies to specific epitopes of gp120 and gp41 revealed differences between long-term survivors and nonsurvivors, implying that responses to specific epitopes may be important in conferring resistance to disease progression.
Amino Acid Sequence↗
Comparison of serum antibody reactivities to a conformational and to linear antigenic sites in the external envelope glycoprotein of simian immunodeficiency virus (SIVmac) induced by infection and vaccination.
Forty-six overlapping peptides (20-mers) representing the amino acid sequence of the external envelope glycoprotein of simian immunodeficiency virus (SIVmac; 32H isolate) were used to investigate linear antigenic sites recognized by antibodies in sera from SIV-infected rhesus macaques and in animals vaccinated with formalin-inactivated SIV. The reactivity to a discontinuous antigenic site as defined by a neutralizing monoclonal antibody was measured by competition assay. The majority of infected macaques recognized three linear antigenic determinants within the V1, V3 and C5 regions of the external glycoprotein. Animals infected with virus derived from the molecular clone SIVmac 32H (pJ5) showed broader reactivity to peptides with half of these animals having antibodies to the V2 region in addition to the V1, V3 and C5 regions. The majority of animals produced antibodies in response to the discontinuous epitope although these responses were weaker in animals infected with molecularly cloned virus. Seven of eight animals given vaccine in syntex adjuvant formulation (saf-1) produced antibodies in response to the discontinuous epitope and all reacted with peptides from the V1, V2 and V3 regions but only half recognized the C5 region. Animals receiving vaccine in alum adjuvant generally showed weaker responses to the discontinuous and linear determinants than those receiving saf-1 adjuvanted vaccine.
Amino Acid Sequence↗
Redesigning nursing practice. The partners in patient care model.
Several nursing practice models use nurse extenders/partners to extend nurses' time. The authors discuss the development, implementation, and evaluation of the "partner in patient care" (PIPC) model. Unique aspects of the model are emphasized, including use of a collaborative process to generate the design and guide the implementation; staff participation throughout the design and implementation of the project; and use of evaluation at each phase of the implementation process to improve on the outcomes.
Computer Terminals↗
Low bone mineral density at axial and appendicular sites in amenorrheic athletes.
Amenorrheic athletes have low axial bone-mineral density (BMD, g.cm-2). We compared 12 amenorrheic and 9 eumenorrheic women athletes to determine whether athletes with amenorrhea have lower BMD in other skeletal regions, including weight-bearing lower limbs. BMD was measured by dual energy x-ray and single photon absorptiometry. Both groups had similar age, body mass, and exercise quantity. Women with amenorrhea missed 86.3 +/- 58.3 menstrual periods since menarche. BMD was lower in the amenorrheic vs eumenorrheic subjects for the lumbar spine (0.928 +/- 0.056 vs 1.050 +/- 0.110, P < 0.005), whole body (1.032 +/- 0.05 vs 1.09 +/- 0.06, P < 0.05), most regions of the whole body (P < 0.05-0.001), all areas of the proximal femur (P < 0.005), and at the femoral mid-shaft (1.333 +/- 0.109 vs 1.491 +/- 0.088, P < 0.005). No significant differences were detected at the mid-radius and tibial shaft. The best predictors of BMD were years of regular menstruation for lumbar spine; and years of amenorrhea for hip, femoral mid-shaft, and whole body. We conclude that low BMD in athletes with amenorrhea is not limited to the axial skeleton but is also present in other regions including appendicular weight-bearing bones.
Absorptiometry, Photon↗