Determining intensive care unit requirements: a continuous quality improvement project.
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Bed Occupancy↗
Biomedical subjects
M Gilbert
Publications and source records attributed to M Gilbert.
[Chances to survive an avalanche--new data].
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Asphyxia↗
Spurious leukocytosis-simulating relapse of chronic myeloid leukemia after bone marrow transplant: possible relationship to hypercholesterolemia and hyperbilirubinemia.
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Adult↗
Bacterial secretion of the Fab fragment of a mouse monoclonal IgM that reacts with IgG variable regions.
In this report, we describe the expression system that enabled us to produce in Escherichia coli the Fab fragment of a mouse IgM that has previously been shown to inhibit the binding of IgG to autoantigens by interacting with their variable regions. In our system, both light chain and heavy chain fragments were put under the control of the malE promoter. The light chain was fused to the MalE signal sequence, while the heavy chain variable and first constant region were fused to the alkaline phosphatase signal sequence. In this system, after induction of the promoter with maltose, the Fab fragment could be detected in a periplasmic extract of the bacteria by Western blotting and also by ELISA. This Fab fragment was purified on a goat anti-mouse immunoglobulin immunoadsorbent and biotinylated. The Fab fragment produced by E.coli reacted with the trinitrophenyl (TNP) hapten and F(ab')2 fragments of mouse IgG and these reactivities could be specifically inhibited by the corresponding soluble antigens. The dissociation constants of this Fab were 1.65 x 10(-6) M for TNP and 5 x 10(-6) M for IgG F(ab')2 fragments, indicating that the affinity of the Fab fragment compared with that of the whole IgM molecule was similar for TNP but was lower for IgG F(ab')2 fragments.
Animals↗
Nimodipine: a drug therapy for treatment of vasospasm.
Cerebral vasospasm presents a challenge for the nursing staff. To date, no effective prevention methods have been identified. The key to decreasing the mortality rates is in discovering a method of preventing or reversing the arterial narrowing caused by vasospasm. The nurse needs to be aware of the theories of vasospasm and the rationale for treatment. Neurologic assessment skills are important for the nurse to detect minimal changes that may indicate vasospasm. Nurses who are informed will be able to provide optimal care to patients with cerebral vasospasm and provide the necessary support for family members. Drug therapy continues to be the first-line defense in treating vasospasm. Nimodipine is a very promising drug with demonstrated effectiveness to reduce the neurologic deficits caused by vasospasm. Further research on the treatment of vasospasm following SAH is currently in progress.
Humans↗
In vivo effects of glucose and insulin on secretion and gene expression of glucagon in rats.
We investigated the effects of insulin and glucose on the control of secretion and gene expression of glucagon in vivo in rats. Animals were studied during 1) a 48-h period of either glucose infusion (hyperglycemia plus hyperinsulinemia; HG-HI rats) or insulin infusion (euglycemia plus hyperinsulinemia; EG-HI rats), and 2) a prolonged postinfusion period in both groups. In HG-HI rats, elevation of plasma insulin and glucose concentrations by about 7 and 5 times, respectively, resulted in a decline in glucagon levels, which fell significantly within 6 h and remained low thereafter, whereas these levels were unchanged in EG-HI rats. Glucagon messenger RNA levels and pancreatic glucagon content were not significantly affected in either HG-HI or EG-HI rats. After cessation of infusions, hypoglycemia occurred in both group of rats. In HG-HI rats, hypoglycemia lasted for about 36 h without any surge in the plasma glucagon level, whereas in EG-HI rats it was transient (approximately 1 h) and stimulated glucagon secretion. In both groups the pancreatic alpha-cell was unresponsive to arginine during the postinfusion period. In conclusion, although a role of intraislet insulin cannot be excluded, glucagon gene expression is insensitive to changes in plasma glucose and insulin concentrations. In contrast, hyperglycemia/hyperinsulinemia, not hyperinsulinemia alone, lowers glucagon secretion and affects the alpha-cell responsiveness to hypoglycemia.
Animals↗
Production and secretion of proteins by streptomycetes.
Streptomycetes produce a large number of extracellular enzymes as part of their saprophytic mode of life. Their ability to synthesize enzymes as products of their primary metabolism could lead to the production of many proteins of industrial importance. The development of high-yielding expression systems for both homologous and heterologous gene products is of considerable interest. In this article, we review the current knowledge on the various factors that affect the production and secretion of proteins by streptomycetes and try to evaluate the suitability of these bacteria for the large-scale production of proteins of industrial importance.
Amino Acid Sequence↗
Coordinated care for the SCI patient.
The delivery of quality patient care in a timely, cost-effective manner is of utmost importance in health care settings. In an attempt to promote continuity and coordination of care, appropriate utilization of resources, and increased patient and health care provider satisfaction, a coordinated care system of patient care delivery was implemented for the spinal cord injured patient. Coordinated care is a multi-disciplinary approach that focuses on achieving patient outcomes within effective time frames which have been established by all members of the health care team involved in the treatment of the SCI patient. Integral to the concept of coordinated care is the utilization of a critical path and variance tracking and analysis. A critical path is a multidisciplinary plan which identifies the time frame in which key events and patient outcomes should occur during an episode of care in order to achieve an optimal use of resources and length of stay. Variance tracking is the comparison of the actual care delivered with the expected plan and the identification of reasons why the care differed.
Case Management↗
Incidence of hepatitis C in patients requiring orthopaedic surgery.
We tested prospectively for hepatitis C virus (HCV) in one orthopaedic surgeon's operative practice for one year. Of 425 consecutive patients, 19 (4.5%) were positive for HCV infection using a second-generation screening assay. The highest correlation with a positive test was the presence of tattoos and the second highest was intravenous drug abuse, but only after a second interview, since most patients did not report this risk on the initial questionnaire. Based on the criteria of the US Public Health Services algorithm, nine (47%) of the patients with a positive initial screening test or 2.2% of the 425 patients, had hepatitis C (both anti-HCV-positive and elevated alanine aminotransferase). In this group of nine, the presence of tattoos had the highest and intravenous drug abuse the second highest correlation, also after the second interview. There is no vaccine available for the prevention of HCV infection, and prophylactic immunoglobulin therapy has no proven value for primary exposure.
Adult↗
Genetic modification of T cell clones to improve the safety and efficacy of adoptive T cell therapy.
Our laboratory has developed methods to isolate human antigen-specific cytolytic CD8+ T cell clones and to expand such clones in vitro to numbers sufficient for T cell therapy of human diseases. Studies in immunocompromised bone marrow transplant patients at high risk for disease associated with cytomegalovirus have demonstrated that administration of more than 10(9) CD8+ T cell clones is safe and can effectively reconstitute a deficient human immune response. Our laboratory is applying this strategy of adoptive therapy to the treatment of human cancer, starting with the subset of patients with Hodgkin's disease who show expression of proteins encoded by the Epstein-Barr virus in their malignant Reed-Sternberg cells. The development of efficient systems such as retroviral vectors for the introduction of genes into primary cells has made it possible to consider overcoming some of the limitations of the effector T cells that normally mediate response to an antigen. Our laboratory is attempting to modify T cell clones by the introduction of genes before transfer as a means to improve the safety and/or efficacy of T cell therapy.
Antigens, Viral↗
Hepatic amino acid metabolism during hyperinsulinemia and hyperaminoacidemia in conscious rabbit during late pregnancy.
To test whether pregnancy has any effect on amino acid metabolism, we examined in two experimental conditions (1) the effect of hyperinsulinemia on the blood concentration and net hepatic balance of amino acids, and (2) the effect of hyperaminoacidemia on the hepatic handling of amino acids. Experiments were performed in conscious virgin and pregnant rabbits after an 18-hour fast. In the first protocol (hyperinsulinemia), an increment in the plasma insulin level (approximately 45 and 20 microU/mL in the portal vein and artery, respectively) with euglycemia maintained causes a similar decrease (approximately 27% to 34%) in blood amino acid concentrations without any changes in the net hepatic uptake of amino acids in both groups of animals. The hepatic uptake of branched-chain amino acids (BCAA) was practically negligible, whereas there was a consistent uptake of gluconeogenic amino acids in pregnant and nonpregnant rabbits. In the second protocol, hyperaminoacidemia leads to a significantly lower increase in the net hepatic uptake of glycine and serine in pregnant rabbits as compared with nonpregnant rabbits. The same trend was observed for the uptake of individual BCAA, but it did not reach statistical significance. We conclude that in pregnant rabbits (1) insulin does not modify the hepatic uptake of amino acids, and its ability to suppress the release of amino acids from peripheral tissues does not seem to be affected when compared with that in nonpregnant animals, and (2) when hyperaminoacidemia occurs, a greater amount of gluconeogenic amino acids (glycine and serine) would escape the liver, suggesting a higher availability of these circulating amino acids for the fetus.
Amino Acids↗
Reactivity and structure of a mouse anti-F(ab')2 IgM. Comparison of its variable region sequences with those of a structurally close polyreactive natural IgM.
IE12 is a monoclonal IgM with strong anti-F(ab')2 activity that inhibits the binding of normal mouse IgG to self antigens. In this study, we found that this IgM was also reactive with several monoclonal antibodies (mAbs), myeloma proteins and B lymphocytes from normal BALB/c mouse. The nucleotide sequences of the variable region of the heavy and light chains of IE12 were determined, and compared to those of another mAb already described in the literature. This mAb uses the same light chain and also the same VH, D and JH segments, but unlike IE12, is polyreactive. The comparison of the amino acid composition of these two mAbs and of the computer predictions for their structure and hydrophilicity indicated that the most striking difference between them was located in the third complementarity determining region (CDR3) of the heavy chain. Indeed, they used the same D segment but translated in two different reading frames, leading to different amino acid compositions. The CDR3 of IE12 contains aliphatic amino acids, while that of the polyreactive IgM does not. In addition, IE12 has two prolines, one at each at each extremity of its D segment, that could confer a certain rigidity to this region. Finally, the CDR3 of IE12 is predicted to be hydrophobic, while the one of the polyreactive IgM is predicted to be hydrophilic and more flexible, suggesting that the hydrophilicity and the flexibility of this region might be critical for polyreactivity.
Amino Acid Sequence↗
Spinal cord stimulation for chronic intractable pain: nursing implications.
Spinal cord stimulation (SCS) became available in the 1970s as a treatment option for patients with constant or recurring pain. This invasive procedure is performed after all other efforts have failed to prove effective in controlling pain. Advanced technology enables the patient to perform adjustments to maximize comfort with the use of a magnet or portable programmer. Nursing care is guided by a specific plan of care for the SCS patient population. A patient population-specific standard may be useful.
Electric Stimulation Therapy↗
Involvement of the autonomic nervous system in the in vivo memory to glucose of pancreatic beta cell in rats.
The fact that the potentiating effect of prolonged hyperglycemia on the subsequent insulin secretion is observed in vivo but not in vitro suggests the involvement of extrapancreatic factors in the in vivo memory of pancreatic beta cells to glucose. We have investigated the possible role of the autonomic nervous system. Rats were made hyperglycemic by a 48-h infusion with glucose (HG rats). At the end of glucose infusion as well as 6 h postinfusion, both parasympathetic and sympathetic nerve activities were profoundly altered: parasympathetic and sympathetic activities, assessed by the firing rate either of the thoracic vagus nerve or the superior cervical ganglion, were dramatically increased and decreased, respectively. Moreover, 6 h after the end of glucose infusion, insulin secretion in response to a glucose load was dramatically increased in HG rats compared to controls. To determine whether these changes could be responsible for the increased sensitivity of the beta cell to glucose, insulin release in response to glucose was measured in HG and control rats, either under subdiaphragmatic vagotomy or after administration of the alpha 2A-adrenergic agonist oxymetazoline. Both treatments partially abolished the hyperresponsiveness of the beta cell to glucose in HG rats. Therefore chronic hyperglycemia brings about changes in the activity of the autonomic nervous system, which in turn are responsible, at least in part, for the generation of enhanced beta cell responsiveness to glucose in vivo.
Action Potentials↗
Factors associated with dropout from group psychotherapy with depressed adolescents.
Attempts to determine the characteristics of those individuals who drop out from psychotherapy have yielded few consistent findings. Clinically depressed adolescents who completed a course of brief group therapy were compared with those who failed to complete treatment. Although no differences were found on a number of clinical and demographic variables, those who dropped out were more likely to be one grade behind in school and to have a history of alcohol and/or drug abuse. The implications of these findings for research and practice are discussed.
Adolescent↗
Chemical risk assessment and international cooperation.
The scope and the main activities as regards the assessment of the risk from chemical exposure are described. During the United Nations Conference of Environment and Development (UNCED) member states recommended that attempts be made to develop a "common framework to risk assessment" and to improve risk assessment methodology. Within agenda 21, chapter 19, the International Programme on Chemical Safety (IPCS) was given the responsibility to undertake this work while taking full account of ongoing activities within other international and multinational or non-governmental groups to complete the task in a timely and cost-effective manner.
Hazardous Substances↗
Early excision of nasal hemangiomas: the L-approach.
The presence of a nasal hemangioma may have a severe negative effect on the personality of a child. Early surgery in the involution phase has proved to be beneficial in this respect. The treatment of a consecutive series of nine patients who had surgery shortly after they were first seen for consultation is discussed. An extended rhinotomy (L-approach) was used in four of these patients. The results were uniformly good.
Child↗
Similarity of primary radical pair recombination in photosystem II and bacterial reaction centers.
We report temperature and magnetic field dependent measurements of the recombination dynamics of the radical pair P680+Pheo- in D1D2cytb559 reaction centers of photosystem II and compare the results to those obtained in bacterial reaction centers. In photosystem II the rate of recombination to the groundstate is found to be slower than in the bacterial reaction centers by a factor of at least 50. This difference arises from the different redox potentials of the pigments of plant and bacterial reaction centers. In contrast, the rate of recombination to the triplet state is similar in all reaction centers, indicating a similar electronic coupling which allows us to conclude upon the structural similarity.
Chlorophyll↗