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Biomedical subjects

M L Evans

Publications and source records attributed to M L Evans.

At least 19 recordsLinked to original sources

Polycaprolactone/glass bioabsorbable implant in a rabbit humerus fracture model.

Research in improved materials and methods for internal fixation has centered on internal fixators made of bioabsorbable materials such as polylactic acid, polyglycolic acid, and polyparadioxanone. These materials have two problems: the first is a postoperative complication related to a delayed inflammatory response; and the second is low strength characteristics. An alternative material developed to alleviate these problems is a composite of phosphate glass fibers embedded in the polymer polycaprolactone, referred to as PCL. In this study, intramedullary pins made of PCL were compared to stainless steel pins in a rabbit humerus osteotomy model. Specimens were harvested at 0, 6, and 12 weeks postoperatively, radiographs and mechanical testing to failure were performed at each time interval, and tissue was examined microscopically at 6 and 12 weeks. Histologic results showed PCL pins to be well tolerated with minimal inflammation around the pin. Mechanical testing revealed the PCL fixation to be weaker initially than the stainless steel fixation. There was significant stress shielding of stainless-steel-healed rabbit humeri when compared to the PCL/bone humeri. All osteotomies immobilized with PCL healed with abundant periosteal callus production.

Absorption

Profile of SB-204269, a mechanistically novel anticonvulsant drug, in rat models of focal and generalized epileptic seizures.

1. Earlier optimization of structure-activity relationships in a novel series of 4-(benzoylamino)-benzopyrans, led to the discovery of SB-204269 (trans-(+)-6-acetyl-4S-(4-fluorobenzoylamino)-3,4-dihydro-2, 2-dimethyl-2H-benzo[b]pyran-3R-ol, hemihydrate), a potent orally-active anticonvulsant in the mouse maximal electroshock seizure threshold (MEST) test. 2. Studies have now been undertaken to determine the effects of SB-204269 in a range of seizure models and tests of neurological deficits in rats. In addition, the compound has been evaluated in a series of in vitro mechanistic assays. 3. SB-204269 proved to be an orally-effective anticonvulsant agent, at doses (0.1-30 mg Kg-1) devoid of overt behavioural depressant properties, in models of both electrically (MEST and maximal electroshock (MEST)) and chemically (i.v. pentylenetetrazol (PTZ) infusion)-evoked tonic extension seizures. However, the compound did not inhibit PTZ-induced myoclonic seizures at doses up to 30 mg kg-1, p.o. 4. SB-204269 also selectively reduced focal electrographic seizure activity in an in vitro elevated K+ rat hippocampal slice model at concentrations (0.1-10 microM) that had no effect on normal synaptic activity and neuronal excitability. 5. In all of these seizure models, SB-204269 was equivalent or better than the clinically established antiepileptic drugs carbamazepine and lamotrigine, in terms of anticonvulsant potency and efficacy. 6. Unlike SB-204269, the corresponding trans 3S,4R enantiomer, SB-204268, did not produce marked anticonvulsant effects, an observation in accord with previous findings for other related pairs of trans enantiomers in the benzopyran series. 7. In the rat accelerating rotarod test, a sensitive paradigm for the detection of neurological deficits such as sedation and motor incoordination, SB-204269 was inactive even at doses as high as 200 mg kg-1, p.o. This was reflected in the excellent therapeutic index (minimum significantly effective dose in the rotarod test/ED50 in the MES test) for SB-204269 of > 31, as compared to equivalent values of only 7 and 13 for carbamazepine and lamotrigine, respectively. 8. At concentrations (> or = 10 microM) well above those required to produce anticonvulsant activity in vivo (i.e. 0.1 microM in brain), SB-204269 did not interact with many of the well known mechanistic targets for established antiepileptic drugs (e.g. Na+ channels or GABAergic neurotransmission). Subsequent studies have shown that the anticonvulsant properties of SB-204269 are likely to be mediated by a novel stereospecific binding site present in the CNS. 9. The overall efficacy profile in rodent seizure models, together with a minimal liability for inducing neurological impairment and an apparently unique mechanism of action, highlight the therapeutic potential of SB-204269 for the treatment of refractory partial and generalized tonic-clonic seizures.

Animals

Cloning, sequence, and expression of a blood group B active recombinant alpha-D-galactosidase from pinto bean (Phaseolus vulgaris).

A cDNA encoding pinto bean alpha-D-galactosidase [E.C. 3.2.1.22] was obtained by amplification of cDNA using highly conserved sequences found in eucaryotic alpha-D-galactosidases. Subsequently a full length Phaseolus cDNA clone was obtained that is 1537 nt long and contains untranslated 5' and 3' sequences. The nucleotide sequence of the cDNA has a high degree of homology with other eucaryotic alpha-D-galactosidase genes. The recombinant alpha-D-galactosidase (rGal) was expressed in Escherichia coli and purified by ion exchange and affinity chromatography. Purified rGal was homogeneous by SDS-PAGE and had relative masses of 40.1 and 45.4 kDa under nonreducing and reducing conditions, respectively. The N-terminal sequence of the expressed protein contained the sequence GNGLGQTPPMG corresponding to that deduced from the cDNA sequence. The native molecular weight for rGal was determined to be 32.18 kDa by Sephacryl S-200 chromatography. The specific activity of the rGal was 349 mu moles of PNP-alpha-D-galactopyranoside hydrolyzed per mg of pure rGal per min. rGal was highly specific for alpha-D-galactosyl residues and degraded B oligosaccharide. No detectable hemagglutinin or protease activity was present in the preparations. Furthermore, rGal was active against the blood group B antigen on native human erythrocytes in cell suspension assays. The only detectable RBC phenotypic change was loss of the B and P1 epitopes. Recombinant Phaseolus vulgaris alpha-D-galactosidase may have useful biotechnical applications in the potential mass production of enzymatically converted, universally transfusable type O RBCs. alpha-D-galactosidase [E.C. 3.2.1.22] has been purified from a variety of procaryotic and eucaryotic species. Most alpha-D-galactosidases have similar low molecular weight substrate specificities, but activity against high molecular weight substrates is variable. Terminal alpha-D-galactoside residues are present in glycoproteins and glycolipids. Some alpha-D-galactosidases have activity against alpha-D-galactosyl residues on cell membrane glycoconjugates. Glycosidases with this property are useful for carbohydrate structural studies and biotechnical applications. Enzymes free of other glycosidase activities with activity near neutral pH are particularly useful for membrane modification studies on native cells. Complex sugar chains in glycolipids and glycoproteins have often been implicated in the growth and development of eucaryotes. In particular, complex sugar chains play an important role in the recognition of self in the immune system. Some alpha-D-galactosidases can modify certain carbohydrate membrane epitopes, thereby modulating the immune response. For example, the blood group B epitope expressed on erythrocytes contains a terminal alpha-D-galactosyl residue. Individuals lacking this antigen produce naturally occurring complement fixing antibodies to the B epitope. Hydrolysis of this terminal saccharide destroys the antigenic activity of the B determinant producing H antigen (blood type O) on erythrocytes. Only rare individuals produce clinically significant antibodies to the H antigen, and therefore, type O red blood cells are "universally" compatible and in great demand. Dhar purified alpha-D-galactosidase isozymes from Phaseolus vulgaris and characterized their activity. To our knowledge, our laboratory, in a brief report, is the first to describe the cloning of the gene and the use of recombinant enzyme for seroconverting blood type B to O cells. This paper describes the cloning, sequence, expression, purification, and characterization of recombinant alpha-D-galactosidase. Activity of the recombinant enzyme on the native human erythrocyte blood group B epitope is shown.

ABO Blood-Group System

The effects of SB 206284A, a novel neuronal calcium-channel antagonist, in models of cerebral ischemia.

The effects of SB 206284A, 1-[7-(4-benzyloxyphenoxy)heptyl] piperidine hydrochloride, have been investigated in vitro on calcium and sodium currents in rat-cultured dorsal root ganglion (DRG) neurones and potassium-mediated calcium influx in rat synaptosomes. Cardiovascular hemodynamic effects in both anesthetized and conscious rats, and neuroprotective activity in in vivo cerebral ischemia models were also investigated. In the rat DRG cells, SB 206284A caused almost complete block of the sustained inward Ca2+ current (IC50 = 2.4 microM), suggesting that the compound is an effective blocker of slowly inactivating, high-voltage calcium current. SB 206284A reduced locomotor hyperactivity in the gerbil bilateral carotid artery occlusion model without affecting ischemia-induced damage in the hippocampal CA1 region. In the rat middle cerebral artery occlusion model, SB 206284A reduced lesion volume in the posterior forebrain, and in the rat photochemical cortical lesion model, lesion volume was reduced even when treatment was delayed until 4 hours after occlusion. At neuroprotective doses, SB 206284A had no cardiovascular effects. These findings show that SB 206284A is a novel calcium channel antagonist that shows neuroprotective properties.

Animals

Quantifying regional hypoxia in human tumors with positron emission tomography of [18F]fluoromisonidazole: a pretherapy study of 37 patients.

PURPOSE: To assess pretreatment hypoxia in a variety of tumors using positron emission tomography (PET) after injection of the hypoxia-binding radiopharmaceutical [18F]fluoromisonidazole ([18F]FMISO). METHODS AND MATERIALS: Tumor fractional hypoxic volume (FHV) was determined in 21 nonsmall cell lung cancer patients, 7 head and neck cancer patients, 4 prostate cancer patients, and 5 patients with other malignancies by quantitative PET imaging after injection of [18F]FMISO (0.1 mCi/kg). The FHV was defined as the proportion of pixels in the imaged tumor volume with a tissue:blood [18F] activity ratio > or = 1.4 at 120-160 min postinjection. A FHV > 0 was taken as evidence for tumor hypoxia. RESULTS: Hypoxia was observed in 36 of 37 tumors studied with FMISO PET imaging; FHVs ranged from 0 to 94.7%. In nonsmall cell lung cancers (n = 21), the median FHV was 47.6% and the range, 1.3 to 94.7%. There was no correlation between tumor size and FHV. In the seven head and neck carcinomas, the median FHV was 8.8%, with a range from 0.2 to 18.9%. In the group of four prostate cancers, the median and range were 18.2% and 0 to 93.9%, while in a group of five tumors of different types the median FHV was 55.2% (range: 21.4 to 85.8%). CONCLUSIONS: Hypoxia was present in 97% of the tumors studied and the extent of hypoxia varied markedly between tumors in the same site or of the same histology. Hypoxia also was distributed heterogeneously between regions within a single tumor. These results are consistent with O2 electrode measures with other types of human tumors. The intra- and intertumor variability indicate the importance of making oxygenation measures in individual tumors and the necessity to sample as much of the tumor volume as possible.

Carcinoma, Non-Small-Cell Lung

Fine-needle aspiration cytology of ameloblastic carcinoma of the maxilla: a rare tumor.

This report describes the cytologic, histologic, and clinical features of an ameloblastic carcinoma of the maxilla occurring in an 83-yr-old white male. A fine-needle aspiration revealed malignant cells with a predominantly small cell type morphology. There were also a few cells of a second type which were more polygonal to spindled with oval to elongate nuclei. A focal amorphous blue-grey matrix was noted in association with these cells. Although the biopsy showed prominent areas of squamous metaplasia, no squamous cells were seen in the cytologic sample.

Aged

A comparison of venovenous and venoarterial extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure.

OBJECTIVE: To compare the efficacy of venovenous to venoarterial bypass in an unselected cohort of infants with refractory cardiorespiratory failure. DESIGN: Retrospective cohort analysis. SETTING: Two tertiary hospitals capable of providing extracorporeal life support for neonates with acute respiratory failure. PATIENTS: All San Diego Regional Extracorporeal Membrane Oxygenation (ECMO) Program patients treated after the adoption of a policy which eliminated traditional restrictions to venovenous support. INTERVENTIONS: Venoarterial or venovenous extracorporeal life support. MEASUREMENTS AND MAIN RESULTS: Fifty-four infants were treated with venovenous bypass; 30 were treated with venoarterial bypass due to unsuccessful placement of the double lumen venovenous catheter or inability to exclude congenital heart disease before cannulation. No patient required conversion from venovenous to venoarterial ECMO. There were no differences in birth weight, gestational age, diagnosis, or pre-ECMO condition in the two groups. Patients who met ECMO criteria early were more likely to be successfully cannulated with a double-lumen venovenous catheter. Severe hemodynamic compromise was present before cannulation in a comparable percentage of venovenous and venoarterial patients. During venovenous bypass, mean Pao2 values were lower but remained in the normoxic range; Paco2 values, ventilatory setting, intravascular volume requirements, inotropic support, and mean duration of ECMO support were not different. The frequency rate of patient and mechanical complications were also comparable, except that the frequency of intravascular thrombosis was significantly lower in patients receiving venovenous ECMO. Survival, the frequency rate of chronic lung disease, and neurodevelopmental outcome were similar in the two groups. CONCLUSIONS: We conclude that venovenous ECMO using a double-lumen venovenous catheter can provide results comparable with venoarterial bypass without the need for carotid artery ligation in an unselected population of neonatal ECMO candidates. In our experience, reported contraindications to venovenous ECMO did not prove to be valid.

Cohort Studies

Substance abuse and dependence in physicians: the Missouri Physicians' Health Program.

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives. This confidential voluntary program of early referral, intervention, treatment, monitoring, and advocacy has been highly successful. The average recovery rate in this study of 146 participants was 94%.

Female

Occupational exposure to permethrin during its use as a public hygiene insecticide.

Permethrin is an active ingredient found in many public hygiene insecticide products and exposure to it was assessed in a survey of 45 professional users. The exposures measured were over a wide range, with more than a 100-fold difference between average levels and the highest levels. Dermal contamination was evident on 93% of the operators, the highest contamination resulting from the use of leaking application equipment, demonstrating that proper maintenance of equipment is vital. Where the insecticide was applied at ground level most contamination was on the legs, indicating the importance of appropriate footwear. Contamination of the hands occurred despite the use of protective gloves, higher levels of contamination occurring when liquids were used. Dermal contamination was not always the principle route of exposure, and high airborne concentrations were linked with use in confined areas. Airborne concentrations were also associated with the physical form of the product used and the treatment method. To help in assessing the effectiveness of protective clothing and control measures, biological monitoring was carried out. Monitoring of metabolites in urine showed that systemic uptake occurred but evidence from toxicological studies indicates that the levels found were well below those considered to cause harm.

Environmental Monitoring

Evaluation of oxygenation status during fractionated radiotherapy in human nonsmall cell lung cancers using [F-18]fluoromisonidazole positron emission tomography.

PURPOSE: Recent clinical investigations have shown a strong correlation between pretreatment tumor hypoxia and poor response to radiotherapy. These observations raise questions about standard assumptions of tumor reoxygenation during radiotherapy, which has been poorly studied in human cancers. Positron emission tomography (PET) imaging of [F-18]fluoromisonidazole (FMISO) uptake allows noninvasive assessment of tumor hypoxia, and is amenable for repeated studies during fractionated radiotherapy to systematically evaluate changes in tumor oxygenation. METHODS AND MATERIALS: Seven patients with locally advanced nonsmall cell lung cancers underwent sequential [F-18]FMISO PET imaging while receiving primary radiotherapy. Computed tomograms were used to calculate tumor volumes, define tumor extent for PET image analysis, and assist in PET image registration between serial studies. Fractional hypoxic volume (FHV) was calculated for each study as the percentage of pixels within the analyzed imaged tumor volume with a tumor:blood [F-18]FMISO ratio > or = 1.4 by 120 min after injection. Serial FHVs were compared for each patient. RESULTS: Pretreatment FHVs ranged from 20-84% (median 58%). Subsequent FHVs varied from 8-79% (median 29%) at midtreatment, and ranged from 3-65% (median 22%) by the end of radiotherapy. One patient had essentially no detectable residual tumor hypoxia by the end of radiation, while two others showed no apparent decrease in serial FHVs. There was no correlation between tumor size and pretreatment FHV. CONCLUSIONS: Although there is a general tendency toward improved oxygenation in human tumors during fractionated radiotherapy, these changes are unpredictable and may be insufficient in extent and timing to overcome the negative effects of existing pretreatment hypoxia. Selection of patients for clinical trials addressing radioresistant hypoxic cancers can be appropriately achieved through single pretreatment evaluations of tumor hypoxia.

Aged

Use of the Edinburgh Postnatal Depression Scale in a southern, rural population in the United States.

1. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for the incidence of postpartum depression in women receiving their pre- and post-partal care at a southern, rural health department maternity clinic. 2. One hundred eighty-one women completed the EPDS during their postpartum visit. Scores on the EPDS ranged from 0 to 27. Thirty-six of the 181 subjects (19.9%) had scores of 12 or more, the threshold identified by Cox, et al. (1987) as indicating women likely to be experiencing postpartum depression. 3. Results support use of the EPDS as a screening tool for postpartum depression in this population.

Depressive Disorder

Intrauterine repair of cleft lip-like defects in lambs with a novel microclip.

Potential for scarless wound healing in fetal surgeries has aroused interest in fetal repair of malformations such as cleft lip. However, current protocols for fetal surgery have entailed fetal externalization, imparting significant risks for mother and fetus. We have developed a unique silver microclip that rapidly approximates tissue, is nonpenetrating, and is well suited for endoscopic use. Using standardized intrauterine surgical techniques, we compared suture versus microclip in the repair of surgically created cleft-like defects in fetal lambs at 124 days' gestation (term, 145 days). Nine fetal lambs were analyzed with bilateral cleft lips; the right cleft was repaired by microclip, seven of the left clefts were repaired by suture, and the remaining two left clefts were not approximated (controls). Results demonstrated excellent wound healing and smooth lip continuity with minimal scar formation after repair by either microclip or suture. The most striking result, however, was in the comparison on intraoperative repair time; the total time for cleft lip repair by microclip averaged 2.5 minutes in contrast to 9.8 minutes for suture. These data suggest a distinct advantage of the microclip in reduction of operative time. Furthermore, its endoscopic application has the potential for making endoscopic fetal surgery a more viable option.

Animals

A randomized cross-over study of the efficacy of codeine phosphate versus Ispaghulahusk in patients with gynaecological cancer experiencing diarrhoea during pelvic radiotherapy.

Diarrhoea is the commonest acute complication during radiotherapy treatment to the pelvis. Codeine phosphate and a low residue diet is the standard therapy for radiation-induced diarrhoea at The Royal Marsden NHS Trust. The hypothesis put forward was that Ispaghulahusk and codeine phosphate were equally effective in the treatment of diarrhoea during radiotherapy. Participants in the study were female patients who had experienced change of bowel habit whilst receiving radiotherapy for their gynaecological cancer. Quantitative data was collected from patient diaries and treatment flow-sheets. Ten patients were randomized into the trial, five to codeine phosphate, and five to Ispaghulahusk. Continuing the trial was questioned after 10 patients had been treated. All five patients in the codeine phosphate arm received adequate control, while the five patients allocated to the Ispaghulahusk arm were all crossed-over to codeine phosphate with resolution of their diarrhoea. The results show that Ispaghulahusk, whilst not totally ineffective at controlling diarrhoea, was significantly less effective than codeine phosphate. Our conclusion is that there is insufficient reason to change to a less effective and less palatable preparation for the control of radiation-induced diarrhoea.

Codeine

Sleep during the week before labor: relationships to labor outcomes.

This correlational study was conducted to examine the relationship between maternal sleep during the nights prior to the onset of labor and labor outcomes of length, type of delivery, and maternal perceptions of labor. Subjects (N = 99) were drawn from childbirth education classes at a women's hospital in the southeastern United States. Subjects completed the Visual Analog Sleep Scale each morning, beginning two weeks prior to their due dates. Following delivery, subjects completed the Perception of Labor and Delivery Scale, and researchers gathered data about their labors. These women reported poor sleep effectiveness coupled with high sleep disturbance; however, there were no significant correlations between sleep quality and length of labor or maternal perceptions of labor for either the night, or the week, prior to the onset of labor. This finding leads us to question the view that disturbed prenatal sleep will interfere with the progress of labor and lead to more cesarean sections.

Adolescent

Intrauterine repair of surgically created defects in mice (lip incision model) with a microclip: preamble to endoscopic intrauterine surgery.

We compared the difference between a nonpenetrating silver microclip and suture on wound healing, inflammatory response, and application time in the repair of surgically created standardized unilateral cleft lip type defects in fetal mice. Excellent lip continuity and dermal reconstitution were achieved by both methods of repair. Furthermore, collagen accumulation did not occur. Occasional mononuclear cells were seen around sutured repairs in contrast to microclipped repairs. The most significant difference, however, was in application time with the microclip requiring an average of 7 seconds (+/- 2) compared to 90 seconds (+/- 15) for suture. We conclude that the microclip offers distinct advantages for intrauterine cleft lip repair: (1) nonpenetrating tissue approximation; (2) less inflammatory response than suture; (3) technically more rapid and less difficult to apply than suture; and (4) can be utilized more readily than suture for endoscopic approaches limiting the risks of fetal surgery for both the mother and the fetus.

Animals

Improving technology: blood glucose testing.

Nurses frequently monitor blood glucose at the patient's bedside, allowing timely assessment and interventions. To meet the Joint Commission on Accreditation of Health Organization's requirements and guidelines from National Committee on Clinical Laboratory Standards and College of American Pathologists, quality control compliance must be maintained. After testing three blood glucose monitors, one institution selected a machine that eliminated handwritten documentation, ensured quality control testing, and improved ease of use.

Blood Glucose Self-Monitoring

The t(14;18) in a patient with de novo acute lymphoblastic leukemia is associated with t(8;9).

Cytogenetic analysis of a bone marrow aspirate from a patient with acute lymphoblastic leukemia (ALL) revealed the presence of a complex karyotype containing the translocation, t(14;18)(q32;q21). Further investigations using fluorescence in situ hybridization (FISH) allowed the characterization of an additional translocation, t(8;9)(q24;p1?). The association of t(14;18)(q32;q21) and t(8;9)(q24;p13) has recently been described in two patients with de novo ALL (Nacheva et al. Blood 1993;82:231-240) and this report supports these findings.

Adult