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Biomedical subjects

R Phillips

Publications and source records attributed to R Phillips.

At least 91 records · Page 5Linked to original sources

Immunogenic HIV variant peptides that bind to HLA-B8 can fail to stimulate cytotoxic T lymphocyte responses.

Cytotoxic T lymphocyte responses in HIV infection can be impaired through variation in the epitope regions of viral proteins such as a gag. We report here an analysis of variant epitope peptides in three gag epitopes presented by HLA B8. Fifteen variant peptides were examined for their binding to HLA-B8; all but one bound at concentrations comparable to known epitopes. All except two of those that bound could be recognized by CTL from an HLA-B8 positive HIV-1-infected patient and were therefore immunogenic. However, in a hemophiliac patient studied in detail, there was a failure to respond to two immunogenic peptide epitopes representing virus present as provirus in the patient's peripheral blood. In one case, the patient's CTL had previously responded to the peptide; in the other case, there was a good response to a peptide of closely related sequence. Thus there was a selective failure of the CTL response to some proviral epitopes. This impaired reaction to new variants could contribute to the loss of immune control of the infection.

Animals↗

NMDA and non-NMDA receptors contribute to synaptic transmission between the medial geniculate body and the lateral nucleus of the amygdala.

We examined whether the NMDA class of excitatory amino acid receptors contribute to synaptic transmission in the pathway connecting the medial geniculate body (MGB) with the lateral nucleus of the amygdala (LA) using extracellular single unit recordings and microiontophoresis. Cells were identified in LA on the basis of responsivity to electrical stimulation of the MGB. For each cell, a level of current was found for the iontophoretic ejection of the NMDA antagonist AP5 that blocked responses elicited by iontophoresis of NMDA, but had no effect on responses elicited by AMPA. Iontophoresis of AP5 with this level of current blocked the excitatory response elicited by MGB stimulation in most cells tested. Microinfusion of AP5 (25, 50, or 100 microM) also blocked the responses. Additional studies tested individual cells with both AP5 and the AMPA antagonist CNQX and showed that blockade of either NMDA or AMPA receptors interferes with synaptic transmission. Finally, iontophoretic ejection of either AP5 or CNQX blocked short-latency (< 25 ms) responses elicited in LA by peripheral auditory stimulation. Together, these results suggest that the synaptic evocation of action potentials in the thalamo-amygdala pathway depends on both NMDA and non-NMDA receptors. We hypothesize that non-NMDA receptors are most likely required to depolarize the cell sufficiently to remove the blockade of NMDA channels by magnesium and NMDA receptors are required to further depolarize the membrane to the level required for action potential generation.

Acoustic Stimulation↗

In vitro endothelialization of photooxidatively stabilized xenogeneic pericardium.

The possibility of improving the performance of heart valve bioprostheses and vascular biografts by means of preendothelialization with cultured autologous cells has been suggested. Such culture techniques are available, but the glutaraldehyde-preserved heart valve prostheses used clinically appear cytotoxic. Recently, dye-mediated photooxidation has been reported to stabilize pericardial tissue, possibly through the cross-linking of collagen fibrils. We have seeded cultured adult human saphenous vein endothelial cells (HSVECs) onto photooxidatively stabilized tissue and investigated the morphologic characteristics 7 days later. A confluent lining of cultured HSVECs similar to native endothelium was demonstrated by scanning electron microscopy. The presence of von Willebrand's factor, an integrin located at the interendothelial cell contacts (PECAM/CD 31), and the basement membrane component collagen type IV was demonstrated using monoclonal antibodies. The results were similar for the HSVECs seeded onto both bovine and porcine pericardial tissues. The results clearly indicate that the dye-mediated photooxidation technique produces a tissue that is cell compatible. Provided the HSVECs remain attached and retain antithrombotic and antiinflammatory properties, this appears to be a feasible way of endothelializing bioprosthetic heart valves before implantation.

Bioprosthesis↗

Obstructive jaundice caused by neuroblastoma managed with temporary cholecystostomy tube.

Neuroblastoma presenting as obstructive jaundice is very rare. The authors present two cases of neuroblastoma, one primary and one recurrent, manifesting as a malignant obstruction of the extrahepatic biliary system. Various methods of biliary decompression were considered in these children including transhepatic or retrograde biliary stenting and internal cholecystoenteric bypass. An attempt at percutaneous transhepatic stent placement failed in one case. In each patient, a simple insertion of a cholecystostomy tube proved effective. Immediately postoperatively, both patients had rapid resolution in symptoms and a decrease in bilirubin levels. Transient mild cholangitis in both children was successfully treated with antibiotics. Chemotherapy reduced the tumor size in each case, and the cholecystostomy tubes were removed within 3 weeks, after cholangiography showed patency of the distal common bile ducts. Temporary cholecystostomy tube drainage and systemic chemotherapy proved to be a safe, simple, and effective method for managing obstructive jaundice caused by neuroblastoma in these two cases.

Antineoplastic Combined Chemotherapy Protocols↗

Deantigenation of human type B erythrocytes with Glycine max alpha-D-galactosidase.

Conversion of erythrocyte membrane B antigen to H antigen produces blood type O which is universally transfusable. If efficient large-scale production of enzymatically converted red blood cells is to be achieved, then optimal conditions for deantigenation must be determined. Cell suspension assays were used to study the blood group B activity of Glycine max (soybean) alpha-D-galactosidase on native human erythrocytes. The enzyme readily hydrolyzed the terminal alpha-D-galactosyl residue of the B antigen, converting it to H antigen. Optimal conditions for the enzymatic conversion of red cells with the Glycine enzyme are described. Normal cell morphology and function were maintained under optimal conditions.

ABO Blood-Group System↗

Characterization of Gallus domesticus alpha-N-acetyl-galactosaminidase blood group A2 activity.

Soluble A antigens and an enzyme-linked immunosorbent assay (ELISA) using type A2 erythrocyte membranes were used to study the activity of an alpha-N-acetyl-galactosaminidase from Gallus domesticus (domestic chicken). The enzyme readily hydrolyzed the terminal N-acetyl-alpha-D-galactosamine of the A antigen under a variety of conditions, converting it to H antigen. Conversion of the A antigen to H antigen produces blood type O, which is universally transfusable. These preliminary studies are important in determining optimal conditions for enzymatic conversion of blood type A to O if efficient large scale production of enzymatically converted, universally transfusable red blood cells is to be achieved.

ABO Blood-Group System↗

Providing student support systems in Project 2000 nurse education programmes--the personal tutor role of nurse teachers.

This paper is based on a seminar integral to a series of workshops designed for teachers within the South East Wales College of Nursing and Midwifery Education, in preparation for the implementation of Project 2000. Providing support for students has always been an inherent, if not formally described, part of a teacher's role. Project 2000 however presents an opportunity for curriculum planning teams to formally address the issue of supporting students. This paper therefore discusses the concept of the personal tutor and suggests that the combination of a personal tutor system and a 'mentorship' scheme in the practice placements, contributes towards the development of an autonomous, confident practitioner on qualification and registration as a nurse.

Education, Nursing, Baccalaureate↗

Prognosis-based futility guidelines: does anyone win? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.

OBJECTIVE: Advocates for health care reform and others claim that significant savings could be achieved if "futile" care were eliminated. Our objective was to provide an initial estimate of the effects of a public policy that would preclude futile life-sustaining treatments, defined as those employed despite < or = 1% chance of surviving for 2 months. DESIGN: Simulation using data from an observational cohort study. SETTING: Five academic medical centers. PATIENTS: Seriously ill hospitalized adults enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT). METHODS: We examined the impact of prognosis-based futility guidelines on survival and hospital length of stay on a cohort of seriously ill adults. We calculated the number of days of hospitalization that would not be used if, on the third study day, life-sustaining treatment had been stopped or not initiated for subjects with estimated 2-month survival probability of < or = 1%. RESULTS: Of the 4301 patients, 115 (2.7%) had an estimated chance of 2-month survival of < or = 1%. All but one of these 115 subjects died within 6 months. Almost 86% died within 5 days of prognosis. At the time of death, 92 subjects (80.0%) had had no attempt at resuscitation; 35 (30.4%) had had a life-sustaining mechanical ventilator withdrawn. A Do-Not-Resuscitate order was written either before (n = 61) or within 5 days (n = 18) of reaching this prognosis for 68.6% of the patients. These 115 subjects had total hospital charges of $8.8 million. By forgoing or withdrawing life-sustaining treatment in accord with a strict 1% futility guideline, 199 of 1,688 hospital days (10.8%) would be forgone, with estimated savings of $1.2 million in hospital charges. Nearly 75% of the savings in hospital days would have resulted from stopping treatment for 12 patients, six of whom were under 51 years old, and one of whom lived 10 months. CONCLUSIONS: Patients at a high risk of dying can be identified prospectively. Implementation of a strict, prognosis-based futility guideline on the third day of a serious illness would result in modest savings.

Adolescent↗

APC mutation associated with late onset of familial adenomatous polyposis.

Familial adenomatous polyposis is an autosomal dominantly inherited disorder. Mutation studies in the corresponding gene (APC) may provide information for predictive tests for persons at risk in affected families. We report here a new mutation in exon 6 (codon 233) of the APC gene and clinical data in a large family with late onset of the disease in most affected persons.

Adenomatous Polyposis Coli↗

An ELISA for blood group specific exoglycosidases.

An enzyme-linked immunosorbent assay (ELISA) for studying erythrocyte A, B and H epitope specific exoglycosidases is described. Human blood type B erythrocyte membranes and Coffea canephora alpha-D-galactosidase were used as a model. Membrane coated microtiter wells were incubated with exoglycosidase, probed with IgM monoclonal antibody, and then with anti-murine mu chain specific alkaline phosphatase conjugate. The assay is useful for studying exoglycosidase modification of the A, B and H epitopes on human erythrocyte membranes as well as in screening prokaryotic and eukaryotic extracts for blood group active enzymes. Furthermore, this technique has the advantage of simplicity, sensitivity, and objectivity of data interpretation.

Blood Group Antigens↗

Pediatric environmental health training. Impact on pediatric residents.

OBJECTIVE: To determine whether incorporation of a course in pediatric environmental health into a pediatric residency program would alter residents' behavior in history taking. DESIGN: Retrospective chart review. SETTING: Large pediatric training hospital in northern California. PARTICIPANTS: Twenty-three children admitted with asthma by 12 pediatric residents in June 1991 and a control group of 28 children admitted with asthma by 17 pediatric residents in June 1990. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: The initial history and physical assessments were examined for all patients with status asthmaticus admitted to Children's Hospital Oakland (Calif) in June 1990 and 1991. Chi-square analysis revealed a significant difference in the number of environmental questions asked in the group trained in pediatric environmental health compared with the group that received no instruction. CONCLUSIONS: The incorporation of a course in pediatric environmental health markedly affected pediatric residents' behavior in assessing environmental causes for common illnesses. We recommend that the course, "Kids and the Environment," be incorporated into other pediatric residency programs, and that the efficacy of the course be determined by chart review.

Asthma↗

Automated detection and quantification of retinal exudates.

Retinal exudates are a common manifestation of vascular damage in a variety of retinal diseases. We have used computerized image analysis to detect and measure the area of exudates from digitized colour fundus slides of patients with diabetic retinopathy and have assessed the repeatability, reproducibility, and accuracy of the technique. The analysis was entirely independent of the operator apart from choice of the region to be analysed. The coefficient of variation for repeatability was between 3% for large areas of exudate and 17% for small areas of exudate. The reproducibility was also within this range. Sensitivity was between 61 and 100% (mean 87%). False-positives were observed in 5 of 30 regions analysed, and these could have been eliminated by using more stringent criteria for selection of images for analysis. Time taken for the analysis was approximately 3 min.

Diabetic Retinopathy↗

A comparison of the cardiac safety and therapeutic efficacy of trimipramine versus doxepin in geriatric depressed patients.

OBJECTIVE: To compare the cardiac safety and therapeutic efficacy of trimipramine and doxepin. DESIGN: A 1-week single-blind placebo period followed by a 5-week randomized double-blind parallel group clinical trial. SETTING: Psychiatric out-patient clinic of a general hospital. PATIENTS: 37 young-elderly patients with a diagnosis of Major Depressive Episode (DSM-III criteria). INTERVENTIONS: Placebo for 1 week, 2 weeks of titration with either drug in the dosage range of 75 mg/day up to a maximum of 200 mg/day. MEASUREMENTS: We measured the psychiatric effects with the Hamilton Rating Scale for Depression, the Hamilton Anxiety Rating Scale, and the Clinical Global Impression Scale. Cardiovascular effects were assessed on 12-lead standard electrocardiograms plus 1-minute rhythm and high speed recordings; orthostatic (lying/standing) blood pressures were also taken. Physical exams, lab tests, cognitive functions (Buschke Selective Reminding Test, Hierarchic Dementia Scale, Word Fluency) and adverse reactions were also noted. RESULTS: Both drugs were equally effective in relieving symptoms of depression and anxiety. The cardiovascular effects of both drugs were minimal. Trimipramine did lower blood pressure but this was without clinical significance. Three trimipramine patients and five doxepin patients developed occasional premature ventricular or atrial contractions. Of these, two trimipramine patients and one doxepin patient were among those with abnormal ECG's at entry. The doxepin patient was withdrawn from the study after 21 days of treatment when the PVC's became increasingly frequent. CONCLUSIONS: Trimipramine and doxepin are equally safe and effective antidepressants in the young-elderly.

Age Factors↗

Comparison of spiramycin and doxycycline for treatment of Chlamydia trachomatis genital infections.

We performed a single blind controlled multicenter study in which we compared the efficacy and safety of 100 mg of doxycycline versus those of 1 g (3 x 10(6) IU) of spiramycin given orally twice daily for 14 days in the treatment of culture-positive Chlamydia trachomatis genitourinary tract infections. A total of 367 patients were enrolled in the study, and 364 patients were evaluable for safety and 265 patients were evaluable for efficacy. The cure rate between treatment groups was not statistically significant, being 98% (125 of 128 patients) in the spiramycin group and 100% (133 of 133 patients) in the doxycycline group. Female patients who received spiramycin were more likely to report dysethesias that resolved after the completion of therapy. The results of the study show that spiramycin is an effective drug for the treatment of C. trachomatis infection and warrants further assessment over a shorter treatment period (7 days) and during pregnancy.

Adult↗

Public-private partnership organizations in health care: cooperative strategies and models.

Value-adding partnerships have emerged as a preferred strategy of private health care providers to achieve high-quality, low-cost provider status. This same strategy can be applied by public sector providers through the creation of public-private partnership organizations (3POs). Strategies to build 3POs between local governments and their medical communities currently under development are outlined. The conceptual and practical aspects of implementing 3POs are presented.

Attitude of Health Personnel↗