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Biomedical subjects

M McEachern

Publications and source records attributed to M McEachern.

13 recordsLinked to original sources

Molecular manifestations and molecular determinants of telomere capping.

Multiple interacting components of the telomere, together with telomerase (and sometimes recombination), determine whether a telomere will be functional, allowing cell proliferation. The various components reinforce each other, providing for a robust and resilient system of protection and replenishment of telomeres. A characteristic of a telomere is that its structural features elicit responses that allow it to be dynamically recapped. Eliciting a DNA damage response through uncapping of a telomere appears to be one way in which telomerase action at that telomere is stimulated. Thus, as long as a timely and appropriate recapping of the telomere is possible, regulated uncapping of a telomere appears to be not only normal, but even required for optimal telomere maintenance. Telomere length and the presence of telomerase provide an example of a pair of interacting components that determine telomere capping function. Telomerase is dispensable in cells with sufficiently long telomeres; but in cells with short telomeres lacking telomerase, cells lose the ability to proliferate, and in some cell types, telomere fusions are increased. However, expressing telomerase can make even very short telomeres functional. Many interesting questions remain as to the mechanisms of these biological effects.

Animals↗

Automated routing of DICOM CT, MR, and CR images: solving the pitfalls of vendor-specific DICOM implementations.

This paper details our experience in developing and implementing an automated DICOM Image Router. This workstation serves as a gateway between image acquisition devices and image display and storage devices. Images are checked for demographic input errors and data format inconsistencies between the source and destination devices. Based on the configured rules, and image may be held for manual correction and/or distributed to multiple locations. Distribution is based on easily configured environmental variables and rules files which may be changed as needed. For example, CT images are typically sent to the archive and to a radiologist's display workstation. If the patient came from the Emergency Department, a copy of the images are sent to a clinician display workstation located in the Emergency Department. If the patient has suffered trauma to the head, a copy of the images are sent to a display workstation in the Neurosurgery Department for possible consultation. The software was developed on a UNIX-based platform and utilizes a Fast Ethernet network. To date, images from a variety of devices have been acquired: General Electric HiSpeed CT/I scanner, General Electric Signa MRI scanner, Philips Thoravision Digital Chest unit, and Fuji AC-3CS Computed Radiography (CR) unit. Each device has presented new challenges in providing a uniform look to patient demographics in the PACS archive. The workstation also provides a buffer in the event of network outages, storing images for later transmission when the network and/or a workstation recover.

Diagnostic Imaging↗

PACS and CR implementation in a level I trauma center emergency department.

Implementation of a picture archive and communication system (PACS) at a large teaching hospital is an expensive and daunting endeavor. The approach taken at the University of Alabama Hospitals has been to assemble an institution-wide system through focused integration of smaller mini-PACS. Recently a mini-PACS using Computed Radiography (CR) has been placed in the Emergency Department (ED) of a Level I Trauma Center completely replacing conventional screen-film radiography. This area of the hospital produces approximately 250 images per day and provided many challenging requirements: the need for rapid radiography; providing good image quality for difficult examinations with potentially uncooperative patients; reproduction of lost films to maintain availability of images to multiple consulting teams; and frequently unknown patient demographics. The PACS includes both vendor-supplied and in-house developed devices for image storage, distribution, and display. Digital images are produced using two photo-stimulable phosphor CR systems. Currently, all radiographic examinations are acquired digitally with production of a hard copy film as well as electronic distribution via the PACS. Interpretation of images is done primarily via hard copy with a goal of transition to soft copy interpretation. This paper discusses the functional requirements of the PACS and solutions to workflow issues arising in the ED.

Alabama↗

The telomere and telomerase: how do they interact?

The tandemly repeated DNA sequence of telomeres is typically specified by the ribonucleoprotein enzyme telomerase. Telomerase copies part of its intrinsic RNA moiety to make one strand of the telomeric repeat DNA. Recent work has led to the concept of a telomere homeostasis system. We have been studying two key physical components of this system: the telomere itself and telomerase. Mutating the template sequence of telomerase RNA caused various phenotypes: (1) mutating specific residues in the ciliate Tetrahymena and two yeasts showed that they are required for critical aspects of telomerase action; (2) certain mutated telomeric sequences caused a previously unreported phenotype, i.e. a strong anaphase block in Tetrahymena micronuclei; and (3) certain template mutations in the telomerase RNA gene of the yeast Kluyveromyces lactis led to unregulated telomere elongation, which in some cases was directly related to loss of binding to K. lactis Rap1p. Using K. lactis carrying alterations in the genes for Rap1p and other silencing components, we proposed a general model for telomere length homeostasis: namely, that the structure and DNA length of the DNA-protein complex that comprises the telomere are key determinants of telomerase access, and hence the frequency of action of telomerase, at the telomere.

Anaphase↗

Quality assurance and quality control of an intensive care unit picture archiving and communication system.

Most radiology departments have established quality assurance (QA) and quality control (QC) programs for conventional film-based image management systems. At many institutions, digital image management systems, or picture archiving and communication systems (PACS), are replacing part or all of the film management system. In these situations, it is important to control the quality of the digital images that are produced. The observed frequency of eight types of image-related errors occurring on an image viewing station located in a medical intensive care unit is reported. Images on the viewing station were checked for 12 consecutive weeks. Film images available in the radiology reading room and digital images on the viewing station were compared with a list of completed examinations produced by the radiological information system. Overall, 1,082 patient examinations were encountered. Seventy-six images (7.02% of all images) were observed with errors. In addition, four previously unencountered types of errors were observed in 11 images (1.01% of all images). The majority of the errors are attributed to interfaces either between information systems or between the PACS and the user. It is concluded that QA-QC procedures are necessary for PACS, and that good interfaces, both between information systems and between humans and computer systems, are essential for successful PACS implementations.

Humans↗

The effect of prophylactic nitroglycerin infusion on the incidence of regional wall-motion abnormalities and ST segment changes in patients undergoing coronary artery bypass surgery.

The effects of nitroglycerin (NTG) on regional wall-motion abnormalities, ST segment changes, and the incidence of myocardial infarction (MI), cardiac failure, and mortality were studied in 30 patients undergoing coronary artery bypass. Patients received continuous infusions of either normal saline or NTG (1 microgram/kg per min [low dose] or 2 micrograms/kg per min [high dose]) beginning at anesthesia and continuing for 4 hours postoperatively. The occurrence of wall-motion abnormalities as detected by transesophageal echocardiography was 38 events in the normal saline group (N = 10). Significantly fewer events (p < 0.05) were recorded in the low dose and high dose NTG groups (20 events and 15 events, respectively) compared to controls. There were no significant differences between the control and NTG groups with regard to the incidence of Holter ST segment events or the incidence of MI, cardiac failure, or cardiac death. NTG reduced the incidence of echocardiographic wall-motion abnormalities in a dose dependent manner while having no significant effect on other parameters examined.

Coronary Artery Bypass↗

Fuzzy control of mean arterial pressure in postsurgical patients with sodium nitroprusside infusion.

We developed a fuzzy control system to provide closed-loop control of mean arterial pressure (MAP) in postsurgical patients in a cardiac surgical intensive care unit setting by regulating sodium nitroprusside (SNP) infusion. The fuzzy controller, originally expert-system-based, was analytically converted to ten nonfuzzy control algorithms, which reduced execution time dramatically. The core of the control algorithms was a nonlinear proportional-integral (PI) controller whose proportional gain and integral gain adjusted continuously according to error and rate change of error of the process output. The gains became larger when process output was far from desired setpoint and smaller when process output was close to desired setpoint, resulting in more dynamic and stable control performance than the regular PI controller, especially when a linear process with time-delay or a nonlinear process was involved. The control algorithms, encoded in C programming language, were implemented to control MAP in patients. Preliminary clinical results showed that the average percentage of time in which MAP stayed between 90% and 110% of the MAP setpoint was 89.31%, with a standard deviation of 4.96%. These were calculated based on 12 patient trials, with total trial time of 95 and 13 min.

Algorithms↗

A patient monitoring system designed as a platform for application development.

This paper presents a patient data monitoring system for use in critical care areas. The system incorporates design criteria from the Institute of Electrical and Electronic Engineers' (IEEE) proposed standards body (P1073), the Medical Information Bus (MIB) and from our design team. Existing hardware and software technology is utilized wherever possible to maintain cost effectiveness. A major design objective is providing a consistent environment in which to develop applications for critical patient care delivery. The system allows applications to be developed without specific knowledge of the configuration of the bedside environment. Therefore, investments in 'user' application development are shielded from changes in patient care delivery technology. The system has been in limited operation in a surgical intensive care unit for several months with prototype applications.

Computer Systems↗

A reappraisal of surgical intervention for acute myocardial infarction.

Eighty-three patients underwent coronary artery bypass during acute evolving myocardial infarction 6.8 +/- 2.8 hours after the onset of symptoms. Linear discriminant analysis of preoperative variables identified predictors of mortality with an accuracy of 84%. Significant predictors in decreasing order of importance were cardiogenic shock, age over 65 years, left ventricular ejection fraction less than or equal to 0.30, cardiac index less than or equal to 2.0 L/min/m2, and absent collateral flow. Time to reperfusion did not influence outcome nor did the infarct-related artery. Hospital mortality was 15.6% (13/83). Among 51 low-risk patients under 65 years of age without cardiogenic shock, there were three deaths (5.9%). Follow-up angiography was performed in 21 patients. The graft patency rate was 94%. Left ventricular ejection fraction improved from 0.39 +/- 0.10 to 0.49 +/- 0.11 (p less than 0.05). Left ventricular end-systolic volume decreased from 53.2 +/- 19.3 ml/m2 to 41.4 +/- 16.8 ml/m2 (p less than 0.05), and end-diastolic volume remained unchanged: 86.2 +/- 21.2 ml/m2 before operation and 78.7 +/- 24.0 ml/m2 after operation (no significant difference). Regional ejection fraction of the infarct area, determined by the centerline method, increased 0.23 +/- 0.15. In contrast, among 215 patients treated by nonsurgical reperfusion (intracoronary thrombolysis or angioplasty, or both), mortality was 13.5%. In this group, reperfusion was successful in 144 patients (67%) and 89 underwent follow-up angiography. Persistent patency of the infarct artery was demonstrated in 73 (82%). Ejection fraction increased from 0.45 +/- 0.10 to 0.50 +/- 0.15 (p less than 0.05). We conclude that preoperative variables enable identification of patients with evolving acute myocardial infarction in whom coronary artery bypass is associated with low operative mortality and improved ventricular performance.

Coronary Artery Bypass↗

Serum oestradiol and ischaemic heart disease--relationship with myocardial infarction but not coronary atheroma or haemostasis.

Elevated oestradiol (E2) levels may be a risk factor for ischaemic heart disease in men, although the mechanisms for the elevation of oestrogen and for its adverse effects remain unclear. We have studied 100 Caucasian males undergoing elective coronary angiography for ischaemic chest pain and measured serum oestradiol, a profile of haemostatic tests, extent of coronary artery disease and evidence of previous myocardial infarction in order to assess any relationships which could explain the effect of elevated serum oestradiol levels. Levels were significantly higher in men with a history of myocardial infarction compared to those without (p less than 0.01), but were unrelated to the extent of coronary disease or to the haemostatic tests. These results suggest that the association of oestradiol with coronary events relates to myocardial infarction, not to atherogenesis, and is not due to any currently measurable alterations of haemostasis. Current beta-adrenoceptor blocker treatment was associated with lower oestradiol and thromboxane B2 concentrations (both, p = 0.06). These incidental findings suggest that further studies of the effects of beta-blockade on oestradiol and thromboxane metabolism are indicated.

Adrenergic beta-Antagonists↗

Preoperative functional anxiety: a conceptual framework.

Preoperative functional anxiety is an important phenomenon for the patient undergoing surgical intervention. Functional anxiety facilitates the patient's ability to cope with surgery. Personal control enhances the patient's coping and modifies anxiety to a functional level. The phenomenon of preoperative functional anxiety and related concepts of coping and locus of control have a direct effect on the concept of postoperative recovery. Current research is focusing primarily on preoperative anxiety levels and postoperative recovery. There is a need for further nursing research to develop nursing theory about the concepts of coping and personal control as they relate to preoperative functional anxiety and postoperative recovery. This paper focuses on the development of a conceptual framework for understanding the biopsychosocial phenomenon of preoperative functional anxiety.

Anxiety↗