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Biomedical subjects

M Clark

Publications and source records attributed to M Clark.

At least 55 records · Page 3Linked to original sources

Comparative analysis of the RED1 and RED2 A-to-I RNA editing genes from mammals, pufferfish and zebrafish.

One type of RNA editing involves the deamination of adenosine (A) residues to inosines (I) at specific sites in specific pre-mRNAs. These inosines are subsequently read as guanosines by the ribosome, with potentially significant consequences for protein sequence. In mammals, two such A-to-I RNA editases are RED1, which edits some serotonin and glutamate receptors, and RED2, with unidentified substrates. To study the evolutionary conservation among these editases, we have isolated homologous genes from the Japanese pufferfish, Fugu rubripes. Fugu has two genes homologous to Red1 that are similar in size and organization and that show a fivefold compaction relative to the human gene; they differ, however, in their base compositional features. The Fugu gene for RED2 is unusually large, spanning more than 50kb; within the largest intron, there is evidence for a novel gene on the opposite strand. Because of these unusual features, the partial genomic structure was determined for the mouse RED2 gene. A partial cDNA for RED1 was also isolated from zebrafish. Comparisons between fish and between fish and mammals of the protein sequences show that the catalytic domains are highly conserved for each gene, while the RNA-binding domains vary within a single protein in their levels of conservation. Different levels of conservation among domains of different functional roles may reflect differences in editase substrate specificity and/or substrate sequence conservation.

Adenosine Deaminase↗

Comparative analysis of the DRADA A-to-I RNA editing gene from mammals, pufferfish and zebrafish.

The DRADA gene in mammals encodes an A-to-I RNA editase, an adenosine deaminase that acts on pre-mRNAs to produce site specific inosines. DRADA has been shown to deaminate specific adenosine residues in a subset of glutamate and serotonin receptors, and this editing results in proteins of altered sequences and functional properties. DRADA thus plays a role in creating protein diversity. To study the evolutionary significance of this gene, we have characterized the genomic structure of DRADA from Fugu rubripes, and compared the protein sequences of DRADA from mammals, pufferfish and zebrafish. The DRADA gene from Fugu is three-fold compacted with respect to the human gene, and contains a novel intron within the large second coding exon. DRADA cDNAs were isolated from zebrafish and a second pufferfish, Tetraodon fluviatilis. Comparisons among fish, and between fish and mammals, of the protein sequences show that the catalytic domains are highly conserved for each gene, while the RNA binding domains vary within a single protein in their levels of conservation. Conservation within the Z DNA binding domain has also been assessed. Different levels of conservation among domains of different functional roles may reflect differences in editase substrate specificity and/or substrate sequence conservation.

Adenosine Deaminase↗

Combination antihypertensive drugs: recommendations for use.

The recommendation for first-line therapy for hypertension remains a beta blocker or diuretic given in a low dosage. A target blood pressure of less than 140/90 mm Hg is achieved in about 50 percent of patients treated with monotherapy; two or more agents from different pharmacologic classes are often needed to achieve adequate blood pressure control. Single-dose combination antihypertension therapy is an important option that combines efficacy of blood pressure reduction and a low side effect profile with convenient once-daily dosing to enhance compliance. Combination antihypertensives include combined agents from the following pharmacologic classes: diuretics and potassium-sparing diuretics, beta blockers and diuretics, angiotensin-converting enzyme (ACE) inhibitors and diuretics, angiotensin-II antagonists and diuretics, and calcium channel blockers and ACE inhibitors.

Adrenergic beta-Antagonists↗

Modulation of human DNA topoisomerase IIalpha function by interaction with 14-3-3epsilon.

Human DNA topoisomerase IIalpha (topo II), a ubiquitous nuclear enzyme, is essential for normal and neoplastic cellular proliferation and survival. Several common anticancer drugs exert their cytotoxic effects through interaction with topo II. In experimental systems, altered topo II expression has been associated with the appearance of drug resistance. This mechanism, however, does not adequately account for clinical cases of resistance to topo II-directed drugs. Modulation by protein-protein interactions represents one mechanism of topo II regulation that has not been extensively defined. Our laboratory has identified 14-3-3epsilon as a topo II-interacting protein. In this study, glutathione S-transferase co-precipitation, affinity column chromatography, and immunoprecipitations confirm the authenticity of these interactions. Three assays evaluate the impact of 14-3-3epsilon on distinct topo II functional properties. Using both a modified alkaline comet assay and a DNA cleavage assay, we demonstrate that 14-3-3epsilon negatively affects the ability of the chemotherapeutic, etoposide, to trap topo II in cleavable complexes with DNA, thereby preventing DNA strand breaks. By electrophoretic mobility shift assay, this appears to be due to reduced DNA binding activity. The association of topo II with 14-3-3 proteins does not extend to all 14-3-3 isoforms. No protein interaction or disruption of topo II function was observed with 14-3-3final sigma.

14-3-3 Proteins↗

Antibody humanization: a case of the 'Emperor's new clothes'?

The antiglobulin response is perceived as a major problem in the clinical development of therapeutic antibodies. Successive technical developments such as chimeric, humanized and, now, fully human antibodies claim to offer improved solutions to this problem. Although there is clear evidence that chimeric antibodies are less immunogenic than murine monoclonal antibodies, little evidence exists to support claims for further improvements as a result of more elaborate humanization protocols.

Animals↗

Creating a strategic management plan for magnetic resonance imaging (MRI) provision.

We were commissioned by the West Midlands NHS Regional Specialized Services Group (RSSG) to formulate a strategic plan for the management of Magnetic Resonance Imaging (MRI) within the West Midlands, UK. We needed to establish whether an increase in MRI provision was required, and if so to develop criteria to shape both the nature and location of MRI provision. We found that the UK had relatively low MRI provision per capita by international standards, and that the West Midlands region of the UK had less than the UK average level of MRI provision per capita. Within the region there was a 'mixed economy' of MRI provision involving fixed site scanners owned by the NHS and private companies, and private sector mobile MRI provision. There was little evidence of inappropriate MRI use, but considerable evidence of under-provision. Most MRI scanners in the region were heavily utilized, and average waiting times for MRI frequently exceeded guidelines (of a maximum 13-week wait for non-urgent MRI scans). Projections from NHS Trusts, MRI suppliers, and experts in the MRI field, led us to the conclusion that demand for MRI was likely to grow by between 12.5 and 18.5% per annum. This implies that 8-14 additional MRI scanners might be required within the West Midlands over the next 5 years, to meet existing, and rising demand for MRI. We therefore developed criteria (outlined in the paper) to enhance the productive and allocative efficiency of the deployment of MRI provision, whilst improving the configuration of MRI with reference to geographical equality of access to MRI.

Decision Making, Organizational↗

Zebrafish Dkk1, induced by the pre-MBT Wnt signaling, is secreted from the prechordal plate and patterns the anterior neural plate.

mRNA injection into the ventral blastomeres of Xenopus embryos of mRNA encoding Wnt pathway genes induces a secondary axis with complete head structures. To identify target genes of the pre-MBT dorsalization pathway that might be responsible for head formation in zebrafish, we have cloned zebrafish dickkopf1 (dkk1), which is expressed in tissues implicated in head patterning. We found that dkk1 blocks the post-MBT Wnt signaling and dkk1 is a target of the pre-MBT Wnt signaling. Dkk1 overexpression in the prechordal plate suggests that Dkk1, secreted from the prechordal plate, expands the forebrain at the expense of the midbrain in the anterior neural plate. Furthermore, dkk1 acts in parallel to the homeobox gene bozozok and bozozok is required for the maintenance of dkk1 expression. The nodal gene squint is also required for the maintenance of dkk1 expression. Among the mutually dependent target genes of the pre-MBT Wnt signaling, dkk1 plays an important role in patterning the anterior head of zebrafish.

Amino Acid Sequence↗

The effect of a dynamic pressure-redistributing bed support surface upon systemic lymph flow and composition.

INTRODUCTION: It has been postulated that lymphatic insufficiency may have a key role in pressure ulcer development. Our hypothesis is that the particular dynamic action of the Airwave mattress directly improves lymphatic circulation compared to conventional hospital mattresses. METHODS: Seven anesthetized sheep (40-48 kg) prepared with chronic prefemoral lymph fistulas and vascular catheters were first placed on a standard hospital mattress. Following 30 minutes of equilibration, a 2 hr control period was started measuring lymph flow and vascular pressures. The standard mattress was then exchanged for an active Airwave mattress (Pegasus Egerton, Ltd.) and after 30 minutes of equilibration monitored as above. After 2.5 hr, the support surface was then switched back to the standard mattress and monitored as before. Data are mean +/- sem. RESULTS: Initially, on the standard mattress, lymph flow was 1.0 +/- 0.2 ml/30 min and increased significantly more than 3 fold on the Aireave mattress to 3.7 +/- 0.7 ml/30 min. Upon return to the standard mattress, lymph flow decreased to 1.2 +/- 0.2 ml/30 min. Hemodynamic variables and arterial blood gases were constant. Lymphatic protein transport increased significantly from 1.3 +/- 0.3 micrograms/min to 4.3 +/- 1.0 micrograms/min when placed on the test mattress and decreased when returned to the standard mattress to 1.3 +/- 0.2 micrograms/min. Similar rates of lymph flow were seen upon a variant of the Airwave mattress (Cairwave Therapy System). CONCLUSIONS: Results support the hypothesis that the Airwave's action increased the lymph flow compared to a standard hospital mattress. The dynamic cycle may act to aid the pumping action of lymphatics by reducing pressure which would otherwise collapse and compress lymphatics leading to local edema and tissue swelling.

Animals↗

Evaluation of a modified cognitive-behavioural programme for weight management.

OBJECTIVE: To evaluate a modified cognitive-behavioural treatment (M-CBT) for weight management which addresses both the psychosocial costs and the physiological health risks of obesity, without a focus on weight loss. DESIGN: Randomized controlled trial comparing M-CBT with standard cognitive-behavioural therapy (S-CBT). SUBJECTS: Sixty-three overweight women with body mass index (BMI) > or = 28 kg/m2, mean age = 47.5 and mean BMI = 35.4. MEASURES: Weight, waist and hip circumference, blood lipids, blood glucose, blood pressure, psychological well-being, depression, self esteem, stress, binge eating, eating style, body image, nutrient intake, aerobic fitness, activity levels, patient satisfaction with treatment. RESULTS: Both M-CBT and S-CBT achieved improvements in a broad range of physical, psychological and behavioural variables. Weight loss in the S-CBT group was greater than in the M-CBT group immediately after treatment, but both groups lost weight. Participants in the M-CBT group continued to lose weight up to the 1 y follow-up. M-CBT was evaluated positively by participants. CONCLUSIONS: Both M-CBT and S-CBT programmes were successful at inducing modest weight loss, as well as improving emotional well-being, reducing distress, increasing activity and fitness, improving dietary quality and reducing cardio-vascular disease risk factors. The improvements were maintained or continued at 1 y follow-up. These results suggest that treatment based on the new weight-control paradigm which emphasizes sustained lifestyle change without emphasis on dieting, can produce modest benefits to health and well-being.

Adipose Tissue↗

Worster-Drought syndrome, a mild tetraplegic perisylvian cerebral palsy. Review of 47 cases.

A retrospective case-note analysis was undertaken of 47 children with a congenital upper motor neurone bulbar palsy (excluding pure speech dyspraxia) to clarify the phenotype of Worster-Drought syndrome (WDS) and to record its associated features and complications. The results revealed that the study children had significant bulbar problems (with 80% still needing a modified diet and a similar number using augmentative communication methods at last review). There were also high rates of predictable bulbar complications (86% had dribbling, 60% had glue ear, gastro-oesophageal reflux in 40%, history of poor nutrition in 40% and aspiration in 40%). Most of the children had additional complex impairments (91% had mild pyramidal tetraplegia, 81% learning difficulties, 60% congenital defects, 41% neuropsychiatric problems and 28% epilepsy). Over half of the children had significant medical problems in the first year, but mean age at diagnosis was 6 years. There were no obvious causes in pregnancy or birth. Six children had a family history of WDS and 32% (12/37) had abnormal neuroimaging including five with bilateral perisylvian polymicrogyria. In our experience, WDS is not uncommon, is relatively easily diagnosed and is crucial not to miss as the management of these children's multiple impairments is complex and requires a careful team approach. WDS falls clearly within the cerebral palsies as a syndrome that includes motor impairment arising from static damage to the brain in early life. The common presence of cognitive, behavioural and seizure impairments strongly supports the cerebral cortical (presumably perisylvian) localization. Its core elements are a suprabulbar paresis, a mild spastic tetraplegia and a significant excess of cognitive and behavioural impairments and epilepsy. The complete overlap in phenotype between WDS and the bilateral perisylvian syndrome leads us to propose that they are the same condition. WDS is startlingly absent from epidemiological studies of the cerebral palsies and rarely diagnosed, presumably because of lack of clinical awareness of the condition and lack of major gross motor impairments.

Adolescent↗

Association of muscle power with functional status in community-dwelling elderly women.

BACKGROUND: Identification of the physiologic factors most relevant to functional independence in the elderly population is critical for the design of effective interventions. It has been suggested that muscle power may be more directly related to impaired physical performance than muscle strength in elderly persons. We tested the hypothesis that peak muscle power is closely associated with self-reported functional status in sedentary elderly community-dwelling women. METHODS: We used baseline data that were collected as part of a 1-year randomized controlled clinical trial of a combined program of strength, power, and endurance training in 80 elderly women (mean age 74.8 +/- 5.0 years) with 3.2 +/- 1.9 chronic diseases, selected for baseline functional impairment and/or falls. RESULTS: Functional status at baseline was related in univariate analyses to physiologic capacity, habitual physical activity level, neuropsychological status, and medical diagnoses. Leg power had the strongest univariate correlation to self-reported functional status (r = -.47, p < .0001) of any of the physiologic factors we tested. In a forward stepwise regression model, leg press power and habitual physical activity level were the only two factors that contributed independently to functional status (r = .64, p < .0001), accounting for 40% of the variance in functional status. CONCLUSIONS: Leg power is a strong predictor of self-reported functional status in elderly women.

Activities of Daily Living↗

Hospitalization in the Program of All-Inclusive Care for the Elderly (PACE): rates, concomitants, and predictors.

BACKGROUND: The Program of All-Inclusive Care for the Elderly (PACE) replicates the model of comprehensive, community-based geriatric care pioneered by On Lok, that enrolls frail older adults who meet states' criteria for nursing home care, and that uses interdisciplinary teams to assess the participants and to deliver care in appropriate settings. As managed care, PACE receives capitated payment from Medicare and Medicaid. Thus, PACE's fiscal incentives are thought to be aligned with the goals of optimizing health, function, and quality of life through the delivery of effective primary, preventive, restorative, supportive, and palliative care and through the avoidance of inappropriate and expensive hospital and nursing home utilization. OBJECTIVES: To describe short-term hospital utilization, hospital discharge diagnoses, time from enrollment to first hospitalization and its clinical predictors, and hospitalization in relation to mortality among PACE participants. METHODS: Data on short-term hospitalization and participants were recovered from PACE's minimum data set. Bed use was evaluated in annual cross-sections of current participants. Primary hospital discharge diagnoses were available for discharges from September 1, 1993 through March 31, 1997. The time from enrollment to hospitalization was calculated for the participants (n = 5478) who were admitted between January 1, 1990 and March 31, 1997. The characteristics of this inception cohort were used to develop a Cox regression model of hospitalization. All PACE deaths were identified and the place of death was recovered, together with the medical records used in the hospital during PACE enrollment or 6 months before death. RESULTS: Bed-days per 1,000 PACE participants per year were comparable with the general Medicare (fee-for-service) population, at 2,046 (in 1998) versus 2014 (in 1997) despite the greater morbidity and disability for PACE participants, as reflected in their enrollment characteristics and primary hospital discharge diagnoses. The time to hospitalization was 773 days (median); 95% confidence interval, 725, 814, and was predicted by disease, treatment, social and demographic factors. Whereas 8% of PACE deaths occurred in acute hospitals, less than one-third of the decedents spent any time in the hospital in the 6-month interval before death. CONCLUSIONS: Overall, short-term hospital utilization among PACE participants is low in contrast with that for other older and disabled populations. Participant predictors of hospitalization in PACE are generally consistent with other studies in older clinical and community populations. Both utilization and risk vary considerably across PACE sites, independent of participant-level risk factors, hence suggesting that further investigation is required to study PACE's management of acute illness and hospitalization decisions. Critical to maintaining PACE's success is an understanding of the independent impact of the organization and the environment of health care on this management.

Activities of Daily Living↗

Diffractive acoustic elements for laser ultrasonics

Laser ultrasonics is an effective means of generating surface acoustic waves (SAWs). We have shown in previous publications how computer-generated holograms (CGHs) can be used to project optical distributions onto the sample surface. These can be used to control both the frequency content and the spatial distribution of the resulting ultrasound field. In this paper the concept is extended further to produce distributions which themselves act as diffractive acoustic elements (DAEs) for SAWs. It is demonstrated how frequency suppression, multiple foci, and frequency selective focusing of Rayleigh waves may be achieved with these elements. Agreement between the distributions predicted from the designs and those actually measured is excellent.

Journal Article↗

The power of song.

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Cultural Characteristics↗

Home or hospital for stroke rehabilitation? results of a randomized controlled trial : I: health outcomes at 6 months.

BACKGROUND AND PURPOSE: We wished to examine the effectiveness of an early hospital discharge and home-based rehabilitation scheme for patients with acute stroke. METHODS: This was a randomized, controlled trial comparing early hospital discharge and home-based rehabilitation with usual inpatient rehabilitation and follow-up care. The trial was carried out in 2 affiliated teaching hospitals in Adelaide, South Australia. Participants were 86 patients with acute stroke (mean age, 75 years) who were admitted to hospital and required rehabilitation. Forty-two patients received early hospital discharge and home-based rehabilitation (median duration, 5 weeks), and 44 patients continued with conventional rehabilitation care after randomization. The primary end point was self-reported general health status (SF-36) at 6 months after randomization. A variety of secondary outcome measures were also assessed. RESULTS: Overall, clinical outcomes for patients did not differ significantly between the groups at 6 months after randomization, but the total duration of hospital stay in the experimental group was significantly reduced (15 versus 30 days; P<0.001). Caregivers among the home-based rehabilitation group had significantly lower mental health SF-36 scores (mean difference, 7 points). CONCLUSIONS: A policy of early hospital discharge and home-based rehabilitation for patients with stroke can reduce the use of hospital rehabilitation beds without compromising clinical patient outcomes. However, there is a potential risk of poorer mental health on the part of caregivers. The choice of this management strategy may therefore depend on convenience and costs but also on further evaluations of the impact of stroke on caregivers.

Aged↗