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Biomedical subjects

Stuart Brown

Publications and source records attributed to Stuart Brown.

14 recordsLinked to original sources

TBLR1 regulates the expression of nuclear hormone receptor co-repressors.

BACKGROUND: Transcription is regulated by a complex interaction of activators and repressors. The effectors of repression are large multimeric complexes which contain both the repressor proteins that bind to transcription factors and a number of co-repressors that actually mediate transcriptional silencing either by inhibiting the basal transcription machinery or by recruiting chromatin-modifying enzymes. RESULTS: TBLR1 [GenBank: NM024665] is a co-repressor of nuclear hormone transcription factors. A single highly conserved gene encodes a small family of protein molecules. Different isoforms are produced by differential exon utilization. Although the ORF of the predominant form contains only 1545 bp, the human gene occupies approximately 200 kb of genomic DNA on chromosome 3q and contains 16 exons. The genomic sequence overlaps with the putative DC42 [GenBank: NM030921] locus. The murine homologue is structurally similar and is also located on Chromosome 3. TBLR1 is closely related (79% homology at the mRNA level) to TBL1X and TBL1Y, which are located on Chromosomes X and Y. The expression of TBLR1 overlaps but is distinct from that of TBL1. An alternatively spliced form of TBLR1 has been demonstrated in human material and it too has an unique pattern of expression. TBLR1 and the homologous genes interact with proteins that regulate the nuclear hormone receptor family of transcription factors. In resting cells TBLR1 is primarily cytoplasmic but after perturbation the protein translocates to the nucleus. TBLR1 co-precipitates with SMRT, a co-repressor of nuclear hormone receptors, and co-precipitates in complexes immunoprecipitated by antiserum to HDAC3. Cells engineered to over express either TBLR1 or N- and C-terminal deletion variants, have elevated levels of endogenous N-CoR. Co-transfection of TBLR1 and SMRT results in increased expression of SMRT. This co-repressor undergoes ubiquitin-mediated degradation and we suggest that the stabilization of the co-repressors by TBLR1 occurs because of a novel mechanism that protects them from degradation. Transient over expression of TBLR1 produces growth arrest. CONCLUSION: TBLR1 is a multifunctional co-repressor of transcription. The structure of this family of molecules is highly conserved and closely related co-repressors have been found in all eukaryotic organisms. Regulation of co-repressor expression and the consequent alterations in transcriptional silencing play an important role in the regulation of differentiation.

Amino Acid Sequence↗

Is contralateral exploration necessary in preterm infants with unilateral inguinal hernia?

PURPOSE: Contralateral inguinal exploration has been the preferred approach to preterm infants with unilateral inguinal hernia. There is no literature evidence to justify this. The aim of this prospective study is to analyze the incidence and to determine any risk factors for the development of contralateral metachronous hernia (MH) in the preterm when compared with term infants. METHODS: Preterm and term infants with unilateral inguinal hernia younger than 6 months who underwent surgery were included. Those infants who subsequently developed MH were analyzed. RESULTS: Two hundred sixty-six patients met the inclusion criteria. One hundred five were preterm and 161 were term. Ten preterm (10.31%) and 9 term infants (5.92%) presented subsequently with MH (P =.18). All but 1 were male. There was no relation between the side of hernia, presentation with incarceration, age at surgery, sex of the patient, and the development of MH. However, a trend toward a higher incidence of MH in very low birth weight and early gestational age preterms was noted. CONCLUSION: There is no significant difference between the occurrence of MH in preterm when compared with term infants. Routine contralateral exploration in preterm infants with its associated risks is therefore not justified in unilateral hernia.

Female↗

Comparison of suture ligation and clip application for the treatment of patent ductus arteriosus in preterm neonates.

OBJECTIVE: We reviewed the experience of 2 centers performing surgical ligation of patent ductus arteriosus in preterm neonates to identify whether the choice of surgical technique--suture ligation or clip application--affected outcome. METHODS: Between 2000 and 2005, 67 newborn infants had open surgical closure of patent ductus arteriosus: 33 by suture ligation and 34 by clip application. The groups were similar in age and sex. RESULTS: The average length of the procedure was 55.8 +/- 13.7 minutes for suture ligation and 30.8 +/- 8.7 minutes for clip application (P < .05). Six neonates had intraoperative bleeding in the suture ligation group. Four patients had significant postoperative complications in the suture ligation group, compared with 2 in the clip application group. CONCLUSIONS: This study demonstrates that clip application results in a significant reduction in the operative time and, possibly, in less morbidity.

Cardiac Surgical Procedures↗

Can armrests improve comfort and task performance in laparoscopic surgery?

OBJECTIVE: The study sought to determine whether the support provided by armrests influenced task quality, task efficiency, and surgeon comfort during laparoscopic surgery. SUMMARY BACKGROUND DATA: Complex laparoscopic surgery requires precise movements, and usually long execution times and an uncomfortable stance. Discomfort in the shoulders, back, and neck is an established complaint among laparoscopic surgeons and is related to the unnatural postures adopted during laparoscopic interventions. Discomfort, and the associated fatigue, is a contributory factor in the execution of errors. METHODS: Nineteen subjects completed a bimanual simulated laparoscopic task both with and without the aid of bilateral armrests. The task was completed in both an ideal unstressed posture and an uncomfortable, stressed elevated posture that more closely represents real laparoscopic operating conditions. Task duration was prolonged sufficiently to precipitate muscular fatigue. The participants also completed a visual analogue scale instrument on level of discomfort symptoms experienced in every part of the upper limbs and vertebral spine. Execution errors (task quality) and completion times (task efficiency) were recorded automatically by the laparoscopic simulator. RESULTS: Error rates and discomfort measures were significantly improved when the armrests were used, but there was no significant change in task completion time. CONCLUSIONS: The use of armrests in simulated laparoscopic surgery brings measurable comfort and task performance benefits, which could transfer to actual surgical procedures.

Adult↗

Evidence-based change of practice in the management of unilateral inguinal hernia.

PURPOSE: Contralateral inguinal exploration in children with unilateral inguinal hernia is still controversial. Only 20% of patients with patent processus vaginalis would develop a clinically apparent hernia [Miltenburg DM, Nutctern JG, Jaksic Tkozinetz CA. Meta-analysis of the risk of metachronous hernia in infants and children. Am J Surg 1997;174:741-4]. In 1999, our unit changed the practice of performing routine contralateral inguinal exploration of male children younger than 2 years and female children younger than 5 years to inguinal herniotomy of the symptomatic side only based on a meta-analysis published by Miltenburg et al [Meta-analysis of the risk of metachronous hernia in infants and children. Am J Surg 1997;174:741-4]. We explored the contralateral inguinal area only in babies with a history of prematurity. METHODS: A prospective study of patients subjected to unilateral inguinal herniotomy from 1999 to 2001 was performed. Age, sex, side of the hernia, and incarceration at presentation were recorded. The incidence of metachronous inguinal hernia (MIH) and its risk factors were analyzed. The follow-up ranged from 36 to 72 months. RESULTS: Of the 409 patients who presented with inguinal hernia, 264 underwent unilateral inguinal herniotomy. The rest were either children with bilateral inguinal hernia or premature babies who were offered bilateral inguinal herniotomy. Of these 264 patients, 180 (68%) had right-sided inguinal hernia and 84 (32%) had left-sided inguinal hernia. Fourteen (5%) patients subsequently presented with MIH. Of these 14 patients, 8 were younger than 2 years at the initial presentation and 11 originally presented with left-sided inguinal hernia. No female child presented with MIH. Twelve (85%) re-presentations with MIH occurred within 1 year of the original operation. CONCLUSIONS: The treatment of only the symptomatic inguinal hernia has not significantly increased the incidence of MIH. This evidence-based change of practice has avoided 152 operations in 264 patients. Presentation with incarceration and age at presentation have no significant impact on the incidence of MIH. Left-sided presentation has a statistically significant high incidence of MIH.

Age Factors↗

CD8+ lymphocytes do not mediate protection against acute superinfection 20 days after vaccination with a live attenuated simian immunodeficiency virus.

In order to test the hypothesis that CD8+ cytotoxic T lymphocytes mediate protection against acute superinfection, we depleted >99% of CD8+ lymphocytes in live attenuated simian immunodeficiency virus macC8 (SIVmacC8) vaccinees from the onset of vaccination, maintained that depletion for 20 days, and then challenged with pathogenic, wild-type SIVmacJ5. Vaccinees received 5 mg per kg of humanized anti-CD8 monoclonal antibody (MAb) 1 h before inoculation, followed by the same dose again on days 3, 7, 10, 13, and 17. On day 13, peripheral CD8+ T lymphocytes were >99% depleted in three out of four anti-CD8 MAb-treated vaccinees. At this time attenuated SIVmacC8 viral RNA loads in anti-CD8 MAb-treated vaccinees were significantly higher than control vaccinees treated contemporaneously with nonspecific human immunoglobulin. Lymphoid tissue CD8+ T lymphocyte depletion was >99% in three out of four anti-CD8 MAb-treated vaccinees on the day of wild-type SIVmacJ5 challenge. All four control vaccinees and three out of four anti-CD8 MAb-treated vaccinees were protected against detectable superinfection with wild-type SIVmacJ5. Although superinfection with wild-type SIVmacJ5 was detected at postmortem in a single anti-CD8 MAb-treated vaccinee, this did not correlate with the degree of preceding CD8+ T lymphocyte depletion. Clearance of attenuated SIVmacC8 viremia coincided with recovery of normal CD8+ T lymphocyte counts between days 48 and 76. These results support the view that cytotoxic T lymphocytes are important for host-mediated control of SIV primary viremia but do not indicate a central role in protection against acute superinfection conferred by inoculation with live attenuated SIV.

Animals↗

Vaccination with live attenuated simian immunodeficiency virus for 21 days protects against superinfection.

The identification of mechanisms that prevent infection with human immunodeficiency virus (HIV) or simian immunodeficiency virus (SIV) would facilitate the development of an effective AIDS vaccine. In time-course experiments, protection against detectable superinfection with homologous wild-type SIV was achieved within 21 days of inoculation with live attenuated SIV, prior to the development of detectable anti-SIV humoral immunity. Partial protection against superinfection was achieved within 10 days of inoculation with live attenuated SIV, prior to the development of detectable anti-SIV humoral and cellular immunity. Furthermore, co-inoculation of live attenuated SIV with wild-type SIV resulted in a significant reduction in peak virus loads compared to controls that received wild-type SIV alone. These findings imply that innate immunity or non-immune mechanisms are a significant component of early protection against superinfection conferred by inoculation with live attenuated SIV.

Animals↗

Transcriptome of axenic liver stages of Plasmodium yoelii.

Plasmodium liver stages or early exo-eythrocytic forms (EEFs) contain antigens that are essential for achieving sterile, protective immunity against malaria. Yet, attempts at identifying these antigens have been hampered by the challenge of obtaining large numbers of purified EEFs, uncontaminated with hepatocyte material. Using a recently described system for producing axenically cultured EEFs from Plasmodium yoelii, we have constructed a cDNA library and generated 1453 expressed sequence tags (ESTs) resulting in 652 unique transcripts. Analysis of the library provides insight into processes required for the initiation and development of Plasmodium liver stages, such as protein degradation, cell cycle progression and nutrient transport. Analysis of the gene expression profile of liver stages, as revealed by this library, suggests that liver stages represent a shift from "sporozoite-like" to "blood-stage-like". This is the first study of the transcriptional repertoire of Plasmodium liver stages.

Animals↗

Aerosolized gamma interferon (IFN-gamma) induces expression of the genes encoding the IFN-gamma-inducible 10-kilodalton protein but not inducible nitric oxide synthase in the lung during tuberculosis.

Gamma interferon (IFN-gamma) is critical in the immune response against Mycobacterium tuberculosis. In an ongoing trial of aerosol IFN-gamma in conjunction with standard drug therapy, we have observed activation of IFN signaling in bronchoalveolar lavage (BAL) cells from tuberculosis (TB) patients. We hypothesized that aerosol IFN-gamma treatment of pulmonary TB would increase expression of genes important for the control of TB. We investigated the expression of downstream genes by measuring inducible nitric oxide synthase (iNOS) and the chemokine IFN-inducible 10-kDa protein (IP-10) by real-time quantitative reverse transcription-PCR. In vitro, M. tuberculosis induced IP-10, and IFN-gamma stimulated this further, with no effect on iNOS expression. We studied 21 patients with pulmonary TB and 7 healthy subjects. Similar to the in vitro model, IP-10 mRNA was increased in BAL cells from TB patients and was augmented after treatment with aerosolized IFN-gamma. TB was also associated with elevated iNOS mRNA, but aerosolized IFN-gamma did not further enhance expression. Genomic analysis identified 1,300 of 4,058 genes expressed in BAL cells from six TB patients before and after 1 month of therapy, including aerosolized IFN-gamma. However, only 15 genes were differentially regulated by IFN-gamma. We conclude that iNOS and IP-10 mRNA expression is increased in TB but that aerosol IFN-gamma treatment increases expression of few genes in the human lung.

Adult↗

Solid-state synthesis of a conducting polythiophene via an unprecedented heterocyclic coupling reaction.

Prolonged storage ( approximately 2 years) or gentle heating (50-80 degrees C) of crystalline 2,5-dibromo-3,4-ethylenedioxythiophene (DBEDOT) affords a highly conducting, bromine-doped poly(3,4-ethylenedioxythiophene) (PEDOT), as confirmed by solid-state NMR, FTIR, CV, and vis-NIR spectroscopies. The novel solid-state polymerization (SSP) does not occur for 2,5-dichloro-3,4-ethylenedioxythiophene (DCEDOT), and requires a much higher temperature (>130 degrees C) for 2,5-diiodo-3,4-ethylenedioxythiophene (DIEDOT). X-ray structural analysis of the above dihalothiophenes reveals short Hal.Hal distances between adjacent molecules in DBEDOT and DIEDOT, but not in DCEDOT. The polymerization may also occur in the melt but is significantly slower and leads to poorly conductive material. Detailed studies of the reaction were performed using ESR, DSC, microscopy, and gravimetric analyses. SSP starts on crystal defect sites; it is exothermic by 14 kcal/mol and requires activation energy of approximately 26 kcal/mol (for DBEDOT). The temperature dependence of the conductivity of SSP-PEDOT (sigma(rt) = 20-80 S/cm) reveals a slight thermal activation. It can be further increased by a factor of 2 by doping with iodine. Using this approach, thin films of PEDOT with conductivity as high as 20 S/cm were fabricated on insulating flexible plastic surfaces.

Journal Article↗

Prevalence of hepatitis A virus infection among sewage workers in Georgia.

BACKGROUND: Wastewater (WW) workers could have opportunity for direct contact with raw sewage, which might contain hepatitis A virus (HAV). METHODS: A serologic survey of WW workers and a comparison population of roads and drainage workers (RD). Factors potentially associated with anti-HAV positivity were evaluated in univariate and multivariate analyses. RESULTS: Among the 365 WW workers, overall anti-HAV prevalence was 38%, similar to that (35%) of the 166 RD workers (P = 0.5). Prevalence varied by wastewater job type from 45% among the 164 field crew workers to 32% among the 201 treatment plant workers. In multivariate modeling, factors associated with anti-HAV positivity included age > or = 40 years (odds ratio [OR] = 2.4; 95% CI = 1.6-3.7), black compared to other races (OR = 2.4; 95% CI = 1.5-3.8), birth outside the United States (OR = 7.5; 95% CI = 3.0-18.6), a high school education or less (OR 2.1; 95% CI = 1.4-3.2) and work on the field crew compared to RD work (OR 1.6; 95% CI = 1.1-2.4). CONCLUSIONS: These results are consistent with no or a small increased risk of hepatitis A among WW workers, and do not provide a clear mandate for hepatitis A vaccination of these workers. Am. J. Ind. Med. 43: 172-178, 2003.

Adult↗

Natural variation of the nef gene in human immunodeficiency virus type 2 infections in Portugal.

Human immunodeficiency virus type 2 (HIV-2) infections cause severe immunodeficiency in humans, although HIV-2 is associated frequently with reduced virulence and pathogenicity compared to HIV-1. Genetic determinants that play a role in HIV pathogenesis are relatively poorly understood but nef has been implicated in inducing a more pathogenic phenotype in vivo. However, relatively little is known about the role of nef in HIV-2 pathogenesis. To address this, the genetic composition of 44 nef alleles from 37 HIV-2-infected individuals in Portugal, encompassing a wide spectrum of disease associations, CD4 counts and virus load, has been assessed. All nef alleles were subtype A, with no evidence of gross deletions, truncations or disruptions in the nef-encoding sequence; all were full-length and intact. HIV-2 long terminal repeat sequences were conserved and also indicated subtype A infections. Detailed analysis of motifs that mediate nef function in HIV-1 and simian immunodeficiency virus, such as CD4 downregulation and putative SH2/SH3 interactions, revealed significant natural variation. In particular, the central P(104)xxPLR motif exhibited wide interpatient variation, ranging from an HIV-1-like tetra-proline structure (PxxP)(3) to a disrupted minimal core motif (P(104)xxQLR). The P(107)-->Q substitution was associated with an asymptomatic phenotype (Fisher's exact test, P=0.026) and low virus loads. These data indicate that discrete differences in the nef gene sequence rather than gross structural changes are more likely to play a role in HIV-2 pathogenesis mediated via specific functional interactions.

Adolescent↗

Palliative care initiative for the Eastern Mediterranean Region: a proposal.

The Eastern Mediterranean Region (EMR), with 22 countries and about half a billion people, has scarce palliative care services that are far from meeting the needs of the region. The authors of this paper believe that the resources and international influence of the World Health Organization could be combined with the excellent palliative care expertise of King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia to establish a collaborative initiative for promotion of palliative care services in the region. This proposal is based on the major components of professional training, development of regional guidelines, integration of palliative care into health plans and polices, and ensuring availability of essential medications. Investment in developing palliative care in the EMR would be expected to relieve the suffering of hundreds of thousands of patients and families in this part of the world.

Fellowships and Scholarships↗