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Biomedical subjects

Peter Kim

Publications and source records attributed to Peter Kim.

At least 19 recordsLinked to original sources

Label-free structural imaging of plant roots and microbes using third-harmonic generation microscopy.

Root biology is pivotal in addressing global challenges including sustainable agriculture and climate change. However, roots have been relatively understudied among plant organs, partly due to the difficulties in imaging root structures in their natural environment. Here we used microfabricated ecosystems (EcoFABs) to establish growing environments with optical access and employed nonlinear multimodal microscopy of third-harmonic generation (THG) and three-photon fluorescence (3PF) to achieve label-free, in situ imaging of live roots and microbes at high spatiotemporal resolution. THG enabled us to observe key plant root structures including the vasculature, Casparian strips, dividing meristematic cells, and root cap cells, as well as subcellular features including nuclear envelopes, nucleoli, starch granules, and putative stress granules. THG from the cell walls of bacteria and fungi also provides label-free contrast for visualizing these microbes in the root rhizosphere. With simultaneously recorded 3PF signal, we demonstrated our ability to investigate root-microbe interactions by achieving single-bacterium tracking and subcellular imaging of fungal spores and hyphae in the rhizosphere.

Plant Roots↗

Biliary atresia with choledochal cyst: implications for classification.

BACKGROUND & AIMS: To illustrate the limitations of the embryonic and perinatal classification system of biliary atresia (BA), we present a child with an antenatal diagnosis of choledochal cyst (CC) associated with BA and review the published literature. METHODS: Medline and Pubmed were searched for "BA and CC," "cystic biliary atresia," "BA and cysts," and "biliary cystic malformations." RESULTS: A 7-week-old with an antenatal diagnosis of CC was found to have BA associated with CC. The literature search identified 88 cases of BA with CC. Sixty-seven cases had type 1 BA (atresia of the common bile duct), 2 had type 2 BA (atresia of the common hepatic duct), and 19 had type 3 BA (atresia of the porta hepatis). Of the 27 cases of antenatal diagnosis of BA with CC only 1 had associated congenital anomalies. Outcome analysis showed poor outcomes were significantly more common (P = .009) and occurred earlier (P = .0249) in patients with type 3 BA. Children with type 3 BA were 5.4 times more likely to develop poor outcomes compared with type 1 (hazard ratio, 5.4; 95% confidence interval, 1.03-27.8). CONCLUSIONS: BA associated with CC forms a distinct subtype of BA, characterized by a preponderance of type 1 BA, a relatively good clinical outcome after surgery, and an absence of associated congenital anomalies. Antenatal diagnosis of many affected infants supports their inclusion within the embryonic BA group and suggests that a broader interpretation of the embryonic phenotype and further classification of BA based on genetic susceptibility may be required.

Biliary Atresia↗

Prevention of chronic renal allograft rejection by SERP-1 protein.

BACKGROUND: In previous studies we have demonstrated that Serp-1, a myxoma virus encoded serine protease inhibitor, dramatically inhibits neointimal hyperplasia in vascular injury and aortic transplant models. Here we examined the effect of peritransplant Serp-1 administration on chronic renal allograft rejection. METHODS: Rat renal transplants were performed with sequential recipient sacrifice on postoperative days 2, 10 and 140 to examine both the acute and chronic effects of Serp-1 in recipient rats. RESULTS: Serp-1 administration reduced early posttransplant injury (POD 2) with less acute tubular and vascular necrosis. This translated into a reduction of the characteristic late stage changes of chronic rejection (POD 140), with significantly decreased glomerulosclerosis and neointimal hyperplasia. Effects of Serp-1 treatment were already evident as early as POD 2 with markedly decreased levels of TGF-beta mRNA witnessed at both the early and late time points (POD 2, 10 and 140). CONCLUSION: We have demonstrated that peritransplant Serp-1 viral protein decreased early injury and allowed reduced chronic rejection in a rat renal model. Recipients treated with Serp-1 are associated with a decrease in TGF-beta mRNA levels in the allografts suggesting that the serine protease inhibitor may inhibit TGF-beta transcription and its profibrotic effects.

Animals↗

Duodenal and biliary atresia associated with facial, thyroid and auditory apparatus abnormalities: a new mandibulofacial dysostosis syndrome?

We report a female child born at 36 weeks of gestation with multiple abnormalities including dysmorphic and coarse facial features with features of mandibulofacial dysostosis that include bilateral microtia with the absence of external auditory meati and Mondini dysplasia as well as, duodenal atresia, intestinal malrotation, anterior displacement of the anus, left hemiaplasia of the thyroid and biliary atresia in sibs. The associations of duodenal atresia with intrahepatic and extrahepatic biliary atresia in sibs have been reported, suggesting an autosomal recessive syndrome. However, the associated external, middle and internal ear anomalies and the thyroid malformation, however, have not been reported in this condition. To the best of our knowledge, this is a hitherto new syndrome with an unknown inheritance.

Abnormalities, Multiple↗

Protracted mumps encephalitis with good outcome.

There is limited published information regarding the outcome of patients with prolonged encephalitis. This report details the case of a patient with an encephalitic illness with a protracted period of coma and a favourable outcome. Extensive investigation revealed seroconversion for mumps infection. A household contact had measles, mumps, rubella (MMR) vaccination 10 days prior to his presentation.

Adult↗

Laser in situ keratomileusis for refractive error after cataract surgery.

PURPOSE: To evaluate the safety and efficacy of laser in situ keratomileusis (LASIK) to correct refractive error following cataract surgery. SETTING: The Eye Institute, Sydney, Australia. METHODS: This retrospective study reviewed 23 eyes (19 patients; 10 female, 9 male) treated with LASIK for refractive error following cataract surgery. The Summit Apex Plus and Ladarvision excimer laser and the SKBM microkeratome were used. The mean age was 63.5 years (range 50 to 88 years). The mean length of follow-up was 8.4 months (range 1 to 12 months) and mean interval between cataract surgery and LASIK was 12 months (range 2.5 to 46 months). RESULTS: The mean preoperative spherical equivalent refraction (SEQ) for myopic eyes was -3.08 +/- 0.84 diopters (D) (range -4.75 to -2.00 D) and for hyperopic eyes was +1.82 +/- 1.03 D (range +0.75 to +3.00 D). The mean improvement following LASIK surgery was greater for myopic than hyperopic eyes (myopic, 2.54 +/- 1.03 D versus hyperopic, 1.73 +/- 0.62 D; P=.033). The percentage of patients within +/-0.5 D of intended refraction post-LASIK surgery was 83.3% for myopic eyes and 90.9% for hyperopic eyes and all eyes were within +/-1.0 D of intended (P<.001). The percentage of eyes with uncorrected visual acuity of 20/40 or better in the myopic group improved from none preoperatively to 91.7% postoperatively (P<.001) and in the hyperopic group improved from 27.3% preoperatively to 90.9% postoperatively (P=.008). No eyes lost 2 or more lines of best corrected visual acuity. CONCLUSION: Laser in situ keratomileusis appears to be effective in correcting refractive error following cataract surgery. Longer-term studies are required to determine refractive stability.

Aged↗

Isolated hypoglycorrachia: leptomeningeal carcinomatosis causing subacute confusion.

We report a 76-year-old caucasian man who presented with a 3-week history of progressive confusion. His past medical history included a left nephro-uretectomy for poorly differentiated transitional cell carcinoma 9 years previously. Besides his confusion, his clinical and neurological examination was unremarkable. Extensive investigation revealed only isolated hypoglycorrachia and mildly elevated CSF protein. Cerebral CT and MRI scans without contrast did not reveal any abnormalities. As his condition continued to decline, an MRI scan of the brain with gadolinium was performed which revealed extensive nodular enhancement of the surface of the cerebellum and brainstem and both temporal lobe convexities. Repeat lumbar puncture showed malignant cells in the CSF and confirmed the diagnosis of leptomeningeal carcinomatosis. This case illustrates that leptomeningeal carcinomatosis should be considered in the differential diagnosis of cognitive decline in the elderly, after other common aetiologies have been excluded. The index of suspicion should be increased in patients with a prior history of cancer.

Aged↗

Incidence of bacteremia after routine tooth brushing.

BACKGROUND: The American Heart Association first developed recommendations on antibiotic prophylaxis against infective endocarditis during dental procedures more than 50 years ago. These recommendations were partly based on the fact that bacteremia occurs with dental procedures. Previous studies in the 1970s and earlier demonstrated that patients become bacteremic after tooth brushing. Improved culture techniques suggest that these rates could be higher now. The objective of this study was to determine the current incidence of bacteremia after routine tooth brushing. METHODS: Thirty military beneficiaries were enrolled in a prospective, institutional review board-approved study after providing informed consent. The incidence of bacteremia after routine tooth brushing for 1 minute using a standardized soft-bristle toothbrush was prospectively measured in 30 healthy adults at three different time points (at baseline and 30 seconds and 20 minutes after brushing). Periodontal Screening and Recording (PSR) scores were recorded for each patient to assess periodontal disease. RESULTS: Three of 180 blood cultures were positive for Propionibacterium acnes (a known contaminant). The remaining blood cultures were all negative. The average PSR score was 9.8 (standard deviation 3.17) for 17 of 30 subjects. CONCLUSIONS: The rate of true bacteremia in this study was zero, which is much lower than previous studies. Bacteremia after tooth brushing in a healthy population is a rare occurrence. Data from previous studies may no longer apply to the current population. Results similar to the ones found in this study during other dental procedures could be an impetus to reevaluate infective endocarditis prophylaxis guidelines.

Adult↗

Peritransplant treatment with cobalt protoporphyrin attenuates chronic renal allograft rejection.

Allogen-independent injury contributes to chronic rejection in renal allografts and heme oxygenase-1 (HO-1) has been shown to be protective in a number of settings. This study evaluated the effect of renal allograft recipient HO-1 up-regulation on chronic rejection in a rat model. Rat (F344 to Lewis) renal transplantation recipients were grouped: (i) cyclosporine (CsA) alone (0.75 mg/kg s.c. x 10 day; n = 5); (ii) CsA + low dose cobalt protoporphyrin (CoPP) an HO-1 inducer (0.5 mg/kg i.p. on days -5,0,5; n = 13) and (iii) CsA + high dose CoPP (5.0 mg/kg i.p. on days -5,0,5; n = 8). Renal function was assessed by serum creatinine levels on day 140. Histopathologic changes in allografts were graded. Morphometric analyses performed to objectively quantify the vascular changes and glomerulosclerosis. HO-1 expression quantified by Western blot and both HO-1 and endothelin (ET-1) localized using immunohistochemistry. Recipients treated with CsA + high dose CoPP had significantly decreased cortical scarring, vascular hyalinization and intimal thickness. They also had a significant, dose-dependent, reduction in luminal obliteration and glomerulosclerosis by morphometric analyses. This freedom from chronic rejection in recipients treated with CoPP translated into quiescent grafts at postoperative day 140 with immunostaining and Western blot demonstrating decreased level of HO-1 versus controls (P = 0.012). In summary, the peritransplant up-regulation of HO-1 in renal allograft recipients significantly attenuates chronic rejection in rat renal allografts by inhibiting transplant vasculopathy.

Animals↗

Bilateral benign lymphoid hyperplasia of the conjunctiva in a paediatric patient.

A 14-year-old boy presented with a 6-month history of bilateral slowly enlarging conjunctival lesions. There was no associated ocular or systemic symptomatology. Examination revealed bilateral salmon-coloured nodular lesions of the bulbar conjunctiva. The remainder of his ophthalmic and general examinations were normal. Extensive investigation excluded regional or systemic involvement. Excision biopsy of the lesions showed a predominantly mature B lymphocyte infiltrate with immunohistochemistry and flow cytometry consistent with reactive lymphoid hyperplasia. Polymerase chain reaction testing for Epstein-Barr virus was negative. At 2 years follow-up, the patient remained healthy and there was no evidence of recurrence. Benign lymphoid hyperplasia of the conjunctiva with bilateral involvement is extremely rare in children. Only a few case reports have been documented in the literature.

Adolescent↗

Role of LRP in TGFbeta2-mediated neuronal uptake of Abeta and effects on memory.

There is increasing evidence that soluble amyloid-beta peptide (Abeta) uptake into neurons is an early event in the pathogenesis of Alzheimer's disease (AD). Identification of the early events leading to neuronal dysfunction is key to developing therapeutic strategies, but relative roles of receptors and factors modulating uptake are poorly understood. Studies have shown that transforming growth factor beta (TGFbeta), particularly TGFbeta2, can influence the targeting of Abeta to cells in vitro. TGFbeta2 can target Abeta to neurons in organotypic hippocampal slice cultures (OHSC). We examine a specific mechanism for TGFbeta2-mediated targeting of Abeta to neurons. The receptor-associated protein (RAP), a low-density lipoprotein receptor-related protein (LRP) antagonist, can attenuate the cellular targeting of Abeta both in vitro and in vivo and prevent Abeta/TGFbeta2-induced memory retention deficits. Using both in vitro and in vivo methods, we identify LRP as playing a role in TGFbeta2-mediated Abeta uptake, neurodegeneration, and spatial memory impairment.

Alzheimer Disease↗

Cognitive decline with chronic meningitis secondary to a COX-2 inhibitor.

Non-steroidal anti-inflammatory drugs are currently being investigated as agents to reduce the incidence and progression of Alzheimer's disease. Paradoxically they have also been reported to induce deleterious effects on the central nervous system, including aseptic meningitis and cognitive decline in the elderly. We report a case of a 72-year-old woman who presented with a 6-week history of profound confusion whilst being treated with rofecoxib, a COX-2 inhibitor. Lumbar puncture demonstrated a lymphocytic pleocytosis with increased protein and normal glucose. Complete clinical remission occurred 5 days after the rofecoxib was ceased with no other cause found despite extensive investigation. This case illustrates that non-steroidal anti-inflammatory drugs, including the new COX-2 inhibitors, can produce chronic lymphocytic meningitis, which may manifest as cognitive decline. This mechanism may account for other case reports and epidemiological evidence of the association between non-steroidal anti-inflammatory drugs and confusion.

Aged↗

Foramen of Morgagni hernia: changes in diagnosis and treatment.

BACKGROUND: Foramen of Morgagni hernias are uncommon diaphragmatic hernias for which there are limited reported data. The purpose of this study is to report a recent case series of foramen of Morgagni hernias in the context of new diagnostic and treatment modalities. METHODS: A retrospective chart review was performed over a 15-year period, from 1987 to 2001. Twelve patients who had a foramen of Morgagni hernia repaired at our hospital were identified, and data from these patients were collected. RESULTS: The average age at treatment was 45 years, with 50% of patients being asymptomatic. Radiographic evaluation included computed tomography scans in two thirds of the patients with a 100% sensitivity for diagnosis. All hernias were right-sided, and the most common contents of the hernias were omentum and colon. The transabdominal route was the preferred surgical approach. Thoracoscopy was used in 2 patients to further characterize a mediastinal mass. Two patients underwent laparoscopic repair. Postoperative complications were infrequent, and there were no recurrences during a 6-month to 10-year follow-up. CONCLUSIONS: The emergence of highly accurate diagnostic computed tomography scans combined with less invasive surgical techniques utilizing laparoscopy and thoracoscopy has aided in the treatment of foramen of Morgagni hernias over the last 15 years.

Adult↗

Sudden visual loss after uneventful cataract surgery: Snuff syndrome.

We describe a case in which the patient had routine, uneventful cataract surgery and developed snuff syndrome on day 1 postoperatively. The patient had pseudoexfoliation syndrome and normal intraocular pressure that was well controlled by timolol and previous laser trabeculoplasty. Although the visual result had been good after surgery in the first (right) eye with a best corrected visual acuity (BCVA) of 6/5, this adverse event, which decreased the BCVA in the left eye from 6/24 preoperatively to hand movements postoperatively, was unexpected. Systemic evaluation failed to identify a specific cause. Data were collected prospectively on 1000 subsequent, consecutive cases of cataract surgery, but we were unable to find pathogenetic data on this occurrence.

Aged↗

Accuracy of the Tonosafe disposable tonometer head compared to the Goldmann tonometer alone.

PURPOSE: To assess the accuracy of the Tonosafe disposable prism tonometer head via a randomised controlled prospective trial. METHODS: The intraocular pressure (IOP) of 69 patients (31 men, 38 women) involving 137 eyes was measured using both the Tonosafe disposable and the Goldmann tono-meter head. The average age of patients was 66.5 years (range 23-93 years). The two examiners (PM and SL) who performed tonometry were masked while a separate observer read the IOP measurements. The order was randomised between Tonosafe and Goldmann devices. The minimum interval between the two measurements was 15 min. Patients with corneal and external diseases were excluded from the study. RESULTS: The mean IOP using the Goldmann tonometer head was 17.44 +/- 4.97 mmHg. The mean IOP using the Tonosafe disposable head was 17.58 +/- 5.03 mmHg. The mean difference was 0.14 +/- 1.73 mmHg (95% CI -0.44, 0.16, P= 0.36). Subgroup analysis on eyes with IOP > 21 mmHg showed the Tonosafe disposable head was on average 0.15 +/- 2.40 mmHg higher than the Goldmann tonometer head. There was a high level of correlation between the IOPs obtained with the Goldmann and Tonosafe heads. Pearson's coefficient of correlation was 0.94 (P < 0.0001). CONCLUSION: The Tonosafe disposable prism head was found to be accurate in IOP measurement, even in the higher range.

Adult↗

Hemolysis with rapid transfusion systems in the trauma setting.

OBJECTIVE: Rapid infusion system allows rapid infusion of resuscitation fluids at body temperature in trauma patients. Packed red blood cells are subjected to high external pneumatic pressure (up to 300 mm Hg) and rapid infusion rates through a 170-microm filter. This study was conducted to outline hemolysis that may occur in the setting of massive transfusion (> 10 units). METHODS AND MATERIALS: Measurements of various parameters were made before and after infusion of 17 units of outdated (38-82 d) packed red blood cells through a Level 1 Rapid Infuser, including lactate dehydrogenase (LDH), potassium, plasma hemoglobin, hematocrit and total hemoglobin. Hemolysis, expressed as a percentage, was calculated from these parameters. RESULTS: Hemolysis observed in this experiment ranged from near 0 to 0.05%. All the units had plasma potassium concentrations of 15 mmol/L or more. CONCLUSION: Transfusion of 17 units with the Level 1 Rapid Infuser did not cause a clinically significant amount of hemolysis.

Blood Transfusion↗