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Biomedical subjects

R P Baker

Publications and source records attributed to R P Baker.

At least 19 recordsLinked to original sources

The proofreading pathway of bacteriophage T4 DNA polymerase.

The base analog, 2-aminopurine (2AP), was used as a fluorescent reporter of the biochemical steps in the proofreading pathway catalyzed by bacteriophage T4 DNA polymerase. "Mutator" DNA polymerases that are defective in different steps in the exonucleolytic proofreading pathway were studied so that transient changes in fluorescence intensity could be equated with specific reaction steps. The G255S- and D131N-DNA polymerases can hydrolyze DNA, the final step in the proofreading pathway, but the mutator phenotype indicates a defect in one or more steps that prepare the primer-terminus for the cleavage reaction. The hydrolysis-defective D112A/E114A-DNA polymerase was also examined. Fluorescent enzyme-DNA complexes were preformed in the absence of Mg2+, and then rapid mixing, stopped-flow techniques were used to determine the fate of the fluorescent complexes upon the addition of Mg2+. Comparisons of fluorescence intensity changes between the wild type and mutant DNA polymerases were used to model the exonucleolytic proofreading pathway. These studies are consistent with a proofreading pathway in which the protein loop structure that contains residue Gly255 functions in strand separation and transfer of the primer strand from the polymerase active center to form a preexonuclease complex. Residue Asp131 acts at a later step in formation of the preexonuclease complex.

2-Aminopurine

Identification of a transient excision intermediate at the crossroads between DNA polymerase extension and proofreading pathways.

DNA polymerases achieve accurate DNA replication through a delicate balance between primer elongation and proofreading. While insufficient proofreading results in DNA replication errors, indiscriminate removal of correct along with incorrect nucleotides is wasteful and may prevent completion of DNA synthesis. The transition between polymerization and proofreading modes is proposed to be governed by a kinetic barrier that prevents proofreading unless the rate of primer elongation is significantly reduced by the presence of an incorrect base pair at the primer-terminus. We have used mutational analysis, coupled with a sensitive, fluorescence-based assay to characterize intermediate steps in the proofreading pathway. A highly fluorescent complex forms between the bacteriophage T4 DNA polymerase and DNA primer-templates labeled at the 3' terminus with the base analog 2-aminopurine. Formation of the fluorescent complex appears to be a rate-determining step in the proofreading pathway and is impaired for several mutator T4 DNA polymerases with amino acid substitutions in the exonuclease domain. Although these mutant DNA polymerases are proficient in hydrolysis, their reduced ability to form the fluorescent complex imposes a higher kinetic barrier. As a consequence, the mutant DNA polymerases proofread less frequently, resulting in more DNA replication errors.

Bacteriophage T4

Head injury at the southeastern Georgia Regional Trauma Center: a three-year review.

The impact of head injury on our trauma center is significant because of the large number of cases with their heavy utilization of trauma center resources. Head injury also exerts a major influence on the Trauma Center in a rural area since it serves as a major provider of care for the head injured over a wide geographical area. Mortality rates seen in this population compare favorably with contemporary data from other studies using GCS and Head AIS as indicators of level of injury.

Craniocerebral Trauma

Pharmacokinetic comparison of three clindamycin phosphate dosing schedules.

In a randomized, three-way crossover study, six male volunteers received clindamycin phosphate 600 mg iv q6h (treatment A), 600 mg iv q8h (treatment B), or 900 mg iv q8h (treatment C). Plasma clindamycin concentrations were determined periodically for eight hours after achieving steady state. The results indicate that treatment C yielded significantly higher peak plasma clindamycin concentrations than treatments A or B. There were no significant differences in minimum plasma clindamycin concentrations (Cmin) or area under the plasma concentration versus time curve (AUC24) between treatments A and C. However, both treatments A and C yielded significantly greater Cmin and AUC24 values than treatment B. There were no significant differences among treatments for clindamycin clearance. It is concluded that clindamycin phosphate 900 mg q8h is a pharmacokinetically acceptable alternative to clindamycin phosphate 600 mg q6h.

Adolescent

Experience with the neodymium:yttrium-aluminum-garnet laser in forty-two cases.

The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been utilized in the treatment of 42 cases during the past 2 years at two institutions. The laser was used under investigational permits from the Food and Drug Administration. It was found to be of particular value in the treatment of vascular intracranial tumors, especially meningiomas, and metastatic tumors of the spine. The ability of the laser to shrink and devascularize these tumors was efficacious as a surgical adjunct. Laser treatment of tumor attachments, especially those of meningiomas to the skull base, seemed to be effective in eradication of residual tumor. Long term benefits of such therapy, however, remain unproven. Because of the penetrating ability of the Nd:YAG laser beam, this device must be used with care by surgeons experienced in its use to prevent injury to adjacent structures.

Humans

Regional cerebral blood flow and metabolism in reversible ischemia due to vasospasm. Determination by positron emission tomography.

Regional cerebral blood flow (rCBF) and regional cerebral metabolic rate of oxygen (rCMRO2) were measured by positron emission tomography (PET) in four patients with subarachnoid hemorrhage and hemiparesis due to cerebral vasospasm. With resolution of the vasospasm, two patients recovered and two remained hemiparetic. Contralateral to the hemiparesis, rCBF was slightly higher in the two patients who eventually recovered (15.0 and 16.2 ml/100 gm/min) than in the two who remained hemiparetic (12.0 and 11.7 ml/100 gm/min). The rCMRO2 measurements showed similar differences, with values of 1.34 and 2.60 ml/100 gm/min in the patients who recovered, and 0.72 and 1.66 ml/100 gm/min in those who did not. These preliminary findings indicate that with PET studies it may be possible to prospectively differentiate patients with neurological deficits due to reversible ischemia from patients with irreversible infarction.

Adult

Cerebral blood volume, blood flow, and oxygen metabolism in cerebral ischaemia and subarachnoid haemorrhage: an in-vivo study using positron emission tomography.

A characteristic sequence of metabolic and haemodynamic changes has been shown to occur in the brain as cerebral perfusion pressure is reduced in experimental animals. Increased cerebral blood volume (CBV) occurs initially, followed by a fall in blood flow (CBF) and, finally, a fall in oxygen metabolism (CMRO2). By measuring CBV, CBF, and CMRO2 with positron emission tomography in patients with vasospasm associated with subarachnoid haemorrhage and in patients with arteriosclerotic occlusion or stenosis of extraparenchymal cerebral arteries, we have demonstrated the presence of similar changes distal to such lesions in man. These findings suggest the presence of a local decrease in perfusion pressure. This study demonstrates the utility of positron emission tomography in the assessment of cerebral circulation and metabolism in man. Measurements of regional CBV must be included for a complete assessment of the dynamics of the cerebral circulation.

Blood Volume

Drug information services: how health care professionals use the information provided.

This study has shown that the Drug Information Service is providing useful information to health professionals and that the information is being applied to patient-specific problems. More research, however, is needed to more concretely document patient outcomes in terms of the length of hospitalization, the number of laboratory tests ordered and the total number and expense of the drugs received.

Consumer Behavior

Shunt fluid examination: risks and benefits in the evaluation of shunt malfunction and infection.

A combined retrospective and prospective study was designed to assess the efficacy of shunt fluid examination in the evaluation of shunt malfunction and/or infection, and to ascertain the complication rate associated with this procedure. Ninety-one patients with shunts for the treatment of hydrocephalus underwent a total of 209 diagnostic shunt "taps." Of 72 instances of mechanical obstruction documented at surgery, 70 were correctly identified by abnormal shunt fluid dynamics, either an opening cerebrospinal fluid (CSF) pressure in excess of the expected valve pressure or absent flow of fluid. The organisms responsible for 12 of 13 shunt-related infections were correctly isolated on initial and all subsequent shunt fluid cultures obtained prior to the institution of appropriate antibiotics. With one infection, a bacterial pathogen was not identified until the third tap. In all instances in which lumbar or ventricular CSF, blood, or wound cultures disclosed an organism, shunt fluid cultures also identified the agent. In addition, these procedures were less reliable. No complications occurred during or immediately following any of the shunt taps. Long-term consequences were assessed in 53 patients with an average follow-up period of 26 months. Some shunt systems subsequently required revision and two infections were documented. The uniformly long interval between the shunt fluid examination and these complications makes it unlikely that the taps contributed to the development of malfunction or infection. Shunt fluid examination appears to be a simple, benign, and yet accurate means of diagnosing shunt malfunction and/or shunt-related infection.

Cerebrospinal Fluid

Complete fracture-dislocation of cervical spine without permanent neurological sequelae. Case report.

A case of complete fracture-dislocation of the lower cervical spine in which there were no permanent neurological sequelae is presented. The absence of permanent neurological deficits with this type of injury is rare. The primary mechanism of injury in this patient was believed to be hyperextension with rupture of the ligamentous structures, allowing complete dislocation of the C-6 body while the posterior elements remained in good alignment due to multiple fractures which "decompressed" the spinal cord.

Fractures, Bone

Serum hepatitis.

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Hepatitis B