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Booker J, Nihart A, Campen M, Medrano-Rodriguez E, Blankenship J. Discharge of Acute Coronary Syndrome Patients on Sub-Optimal Dual Anti-Platelet Therapy: A Single Center Experience. Res Sq 2023:rs.3.rs-3425525. [PMID: 37886454 PMCID: PMC10602150 DOI: 10.21203/rs.3.rs-3425525/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Purpose To identify and quantify the reasons why acute coronary syndrome (ACS) patients undergoing stenting at University of New Mexico Hospital were prescribed sub-optimal dual antiplatelet therapy (DAPT) at discharge, and to identify practice patterns that could potentially lead to improved DAPT treatment for these patients. Methods We reviewed electronic medical records and cardiac catheterization records of 326 patients who underwent PCI at UNMH between January 1, 2021, and June 30, 2022 and identified 229 ACS patients who survived until discharge. Demographic and clinical characteristics relevant to P2Y12 selection were obtained from a review of medical records. Pharmacists' notes that documented their efforts to get appropriate insurance coverage and reasons for discharge on clopidogrel rather than ticagrelor were reviewed. Patients discharged on aspirin and clopidogrel underwent review of medical records and cardiac catheterization lab records to determine if the discharge P2Y12 drug was appropriate. Reasons for inappropriately discharge on clopidogrel were categorized as cost/insurance, patient preference, concern for daily adherence to a twice-daily medication, and on clopidogrel before PCI and not switched to ticagrelor afterward. Results The 229 ACS patients included (38.0%, n = 87) appropriately discharged on ticagrelor/prasugrel, (27.5%, n = 63) appropriately discharged on clopidogrel, (32.8%, n = 75) inappropriately discharged on clopidogrel, and (1.7%, n = 4) not discharged on a P2Y12 inhibitor. For patients inappropriately discharged on clopidogrel (n = 75), the most common reasons were cost or lack of insurance (n = 56) and clinical inertia (taking clopidogrel before PCI and maintained on it afterward) (n = 17). Inappropriate DAPT at discharge correlated with lack of insurance (90.5% compared to 39.7% in patients with insurance, P < 0.001) but not with ethnicity. Conclusion At the University of New Mexico, a safety-net hospital, increasing financially restricted access to ticagrelor could help up to 24.5% of ACS patients reduce their risk of ischemic events. For patients admitted on clopidogrel DAPT, upgrading to ticagrelor could reduce ischemic risk in 7.4% of ACS patients. Expanding healthcare insurance coverage might redue sub-optimal DAPT coverage.
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Dehghani P, Singh J, Singer Z, Booker J, Lavoie AJ, Zimmermann RH, Shavadia JS, Webb JG, Clavel MA, Pibarot P. Catheter-Induced Postextrasystolic Potentiation in the Assessment of Severity of Low-Gradient Aortic Valve Stenosis. Circ Cardiovasc Interv 2023; 16:e012892. [PMID: 37125538 DOI: 10.1161/circinterventions.123.012892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Deciphering which patients with low-gradient aortic valve disease have severe stenosis can be difficult. We aimed to correlate the postextrasystolic potentiation (PESP) with dobutamine stress echocardiography and multidetector computed tomography in patients with low-gradient aortic valve stenosis. METHODS Patients with an aortic valve area ≤1 cm2 and a mean gradient <40 mm Hg were included. Aortic valve stenosis severity was assessed by a core lab with dobutamine stress echocardiography, followed by a multidetector computed tomography aortic valve score if indeterminate. A premature ventricular contraction was induced by intentional catheter contact with the myocardium within the left ventricle. PESP was calculated as a percent change of pre-to-post mean gradient. Multidetector computed tomography was used to measure the aortic valve calcification score, and subsequently, aortic valve calcification density. RESULTS Twenty-eight patients (age, 77±10 years; 19 female) were included. Dobutamine stress echocardiography increased mean gradient from baseline of 25±7 mm Hg to 36±11 mm Hg; pre-premature ventricular contraction mean gradient was 25±7 mm Hg and increased to post-premature ventricular contraction mean gradient of 32±10 mm Hg, representing a PESP of 24±11%. A ≥20% in PESP resulted in 100% sensitivity, 77% specificity, 83% positive predictive value, and 100% negative predictive value for diagnosing severe aortic valve stenosis. There was a significant correlation between PESP and projected aortic valve area and aortic valve calcification density (R=-0.64, P=0.0003; R=0.057, P=0.014, respectively). CONCLUSIONS In patients with low-gradient aortic valve stenosis, catheter-induced premature ventricular contractions during cardiac catheterization causing ≥20% PESP has a 100% sensitivity for severe aortic valve stenosis. Validation of this 20% cutoff in larger groups with correlation to clinical end points is required.
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Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Zachary Singer
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Jeffrey Booker
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Andrea J Lavoie
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Rodney H Zimmermann
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Jay S Shavadia
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - John G Webb
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Marie-Annick Clavel
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Philippe Pibarot
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
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Adegboye O, Churchill J, Moorjani J, Johnson H, Capper S, Booker J, Parnham A, Lau M, Sangar V, Faivre-Finn C. Electronic patient-reported outcome measures (ePROMs) - ready for prime time in penile cancer care? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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McInally SG, Hagen KD, Nosala C, Williams J, Nguyen K, Booker J, Jones K, Dawson SC. Robust and stable transcriptional repression in Giardia using CRISPRi. Mol Biol Cell 2018; 30:119-130. [PMID: 30379614 PMCID: PMC6337905 DOI: 10.1091/mbc.e18-09-0605] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Giardia lamblia is a binucleate protistan parasite causing significant diarrheal disease worldwide. An inability to target Cas9 to both nuclei, combined with the lack of nonhomologous end joining and markers for positive selection, has stalled the adaptation of CRISPR/Cas9-mediated genetic tools for this widespread parasite. CRISPR interference (CRISPRi) is a modification of the CRISPR/Cas9 system that directs catalytically inactive Cas9 (dCas9) to target loci for stable transcriptional repression. Using a Giardia nuclear localization signal to target dCas9 to both nuclei, we developed efficient and stable CRISPRi-mediated transcriptional repression of exogenous and endogenous genes in Giardia. Specifically, CRISPRi knockdown of kinesin-2a and kinesin-13 causes severe flagellar length defects that mirror defects with morpholino knockdown. Knockdown of the ventral disk MBP protein also causes severe structural defects that are highly prevalent and persist in the population more than 5 d longer than defects associated with transient morpholino-based knockdown. By expressing two guide RNAs in tandem to simultaneously knock down kinesin-13 and MBP, we created a stable dual knockdown strain with both flagellar length and disk defects. The efficiency and simplicity of CRISPRi in polyploid Giardia allows rapid evaluation of knockdown phenotypes and highlights the utility of CRISPRi for emerging model systems.
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Affiliation(s)
- S G McInally
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA 95616
| | - K D Hagen
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA 95616
| | - C Nosala
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA 95616
| | - J Williams
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA 95616
| | - K Nguyen
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA 95616
| | - J Booker
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA 95616
| | - K Jones
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA 95616
| | - Scott C Dawson
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA 95616
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Sin P, Yang A, Pon Q, Lavoie A, Crawford J, Harenberg S, Zimmermann R, Booker J, Kelly S, Lavi S, Cantor W, Mehta S, Bagai A, Goodman S, Cheema A, Dehghani P. EFFECTS OF BASELINE PLATELET REACTIVITY IN FIBRINOLYSIS-TREATED ST ELEVATION MYOCARDIAL INFARCTION PATIENTS UNDERGOING EARLY PERCUTANEOUS CORONARY INTERVENTION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Dehghani P, Lavoie A, Booker J, Kelly S, Zulyniak L, Semchuk B, Zimmermann R. The First 100 Patients Started on Ticagrelor in Southern Saskatchewan: The Regina Prospective Ticagrelor Registry. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alli O, Booker J, Lennon R, Greason K, Rihal C, Holmes DR. Reply. JACC Cardiovasc Interv 2012. [DOI: 10.1016/j.jcin.2012.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Howarth D, Slater S, Lau P, Booker J, Clark D, Sillar R. Complementary role of adjunctive breast magnetic resonance imaging and scintimammography in patients of all ages undergoing breast cancer surgery. ACTA ACUST UNITED AC 2005; 49:289-97. [PMID: 16026435 DOI: 10.1111/j.1440-1673.2005.01438.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aims of this study were to assess breast MRI and scintimammography (SMM) for the detection of breast cancer, and to determine any complementary role of these tests to each other and conventional imaging. Seventy-two patients (age 35-81 years) with a suspicious breast mass were investigated by mammography, breast ultrasound, breast MRI and SMM before undergoing surgical excision of the breast mass. Sensitivity, specificity and area under receiver operator characteristic curves were calculated for each test. Of the 72 patients, there were 66 proven malignant tumours, including two patients with bilateral breast cancer. When comparing the diagnostic sensitivity of breast MRI and SMM for lesion size, both tests showed higher sensitivities for lesions >25 mm in size, particularly for SMM. When these tests were compared for patient age, patients less than 51 years showed higher sensitivities for both tests. This was statistically significant for breast MRI. The overall respective diagnostic sensitivities for mammography, mammography with breast ultrasound, breast MRI and SMM were 56, 67, 86 and 85%. The differences were significant between mammography, mammography/ultrasound and both breast MRI and SMM. Breast MRI and SMM offer incremental diagnostic advantage in the diagnosis of breast cancer. Although improved diagnostic accuracy is seen in patients of all ages, those patients less than 51 years of age receive the greatest diagnostic benefit.
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Affiliation(s)
- D Howarth
- Hunter Imaging Group, Pacific Medical Imaging, Newcastle, New South Wales, Australia.
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Howarth D, Epstein M, Lan L, Tan P, Booker J. Determination of the optimal minimum radioiodine dose in patients with Graves' disease: a clinical outcome study. Eur J Nucl Med 2001; 28:1489-95. [PMID: 11685491 DOI: 10.1007/s002590100621] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2001] [Accepted: 07/12/2001] [Indexed: 10/27/2022]
Abstract
The study was performed under the auspices of the International Atomic Energy Commission, Vienna, Austria, with the aim of determining the optimal minimum therapeutic dose of iodine-131 for Graves' disease. The study was designed as a single-blinded randomised prospective outcome trial. Fifty-eight patients were enrolled, consisting of 50 females and 8 males aged from 17 to 75 years. Each patient was investigated by clinical assessment, biochemical and immunological assessment, thyroid ultrasound, technetium-99m thyroid scintigraphy and 24-h thyroid 131I uptake. Patients were then randomised into two treatment groups, one receiving 60 Gy and the other receiving 90 Gy thyroid tissue absorbed dose of radioiodine. The end-point markers were clinical and biochemical response to treatment. The median follow-up period was 37.5 months (range, 24-48 months). Among the 57 patients who completed final follow-up, a euthyroid state was achieved in 26 patients (46%), 27 patients (47%) were rendered hypothyroid and four patients (7%) remained hyperthyroid. Thirty-four patients (60%) remained hyperthyroid at 6 months after the initial radioiodine dose (median dose 126 MBq), and a total of 21 patients required additional radioiodine therapy (median total dose 640 MBq; range 370-1,485 MBq). At 6-month follow-up, of the 29 patients who received a thyroid tissue dose of 90 Gy, 17 (59%) remained hyperthyroid. By comparison, of the 28 patients who received a thyroid tissue dose of 60 Gy, 17 (61%) remained hyperthyroid. No significant difference in treatment response was found (P=0.881). At 6 months, five patients in the 90-Gy group were hypothyroid, compared to two patients in the 60-Gy group (P=0.246). Overall at 6 months, non-responders to low-dose therapy had a significantly larger thyroid gland mass (respective means: 35.9 ml vs 21.9 ml) and significantly higher levels of serum thyroglobulin (respective means: 597.6 microg/l vs 96.9 microg/l). Where low-dose radioiodine treatment of Graves' disease is considered, a dose of 60 Gy will yield a 39% response rate at 6 months while minimising early hypothyroidism. No significant advantage in response rate is gained by using a dose of 90 Gy. For more rapid therapeutic effect at the expense of an increased rate of hypothyroidism, doses in excess of 120 Gy may be required. Ultrasound determination of thyroid mass and measurement of serum thyroglobulin levels may be predictive of those patients who will be less responsive to low-dose therapy.
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Affiliation(s)
- D Howarth
- Pacific Medical Imaging, Newcastle, NSW, Australia.
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Wei W, Unsworth M, Jones A, Booker J, Tan H, Nelson D, Chen L, Li S, Solon K, Bedrosian P, Jin S, Deng M, Ledo J, Kay D, Roberts B. Detection of widespread fluids in the Tibetan crust by magnetotelluric studies. Science 2001; 292:716-9. [PMID: 11326096 DOI: 10.1126/science.1010580] [Citation(s) in RCA: 349] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Magnetotelluric exploration has shown that the middle and lower crust is anomalously conductive across most of the north-to-south width of the Tibetan plateau. The integrated conductivity (conductance) of the Tibetan crust ranges from 3000 to greater than 20,000 siemens. In contrast, stable continental regions typically exhibit conductances from 20 to 1000 siemens, averaging 100 siemens. Such pervasively high conductance suggests that partial melt and/or aqueous fluids are widespread within the Tibetan crust. In southern Tibet, the high-conductivity layer is at a depth of 15 to 20 kilometers and is probably due to partial melt and aqueous fluids in the crust. In northern Tibet, the conductive layer is at 30 to 40 kilometers and is due to partial melting. Zones of fluid may represent weaker areas that could accommodate deformation and lower crustal flow.
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Affiliation(s)
- W Wei
- Department of Applied Geophysics, China University of Geosciences, Beijing, People's Republic of China
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12
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Booker J, Cowan RA, Logue JP, Wylie JP, Eardley A. Evaluation of a nurse-led telephone clinic in the follow-up of patients with prostate cancer. Clin Oncol (R Coll Radiol) 2001; 12:273. [PMID: 11005699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Castro GA, Bouldin PA, Farver DW, Maugans LA, Sanders LC, Booker J. The InterCon network: a program for education partnerships at the University of Texas-Houston Health Science Center. Acad Med 1999; 74:363-365. [PMID: 10219211 DOI: 10.1097/00001888-199904000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The University of Texas-Houston Health Science Center (UT-Houston) has created programs and activities to address the state's pressing needs in minority education. Through InterCon, a network of universities and K-12 schools, UT-Houston works with its partners to identify competitive candidates in the current pool of minority graduates with bachelor's degrees and to help them--along with their non-minority counterparts--progress in their education. Another objective is to expand the pool of minorities underrepresented in medicine who complete high school and go to college. In 1994 UT-Houston and Prairie View A&M University created a collaborative venture to provide new educational opportunities at UT-Houston for Prairie View's predominantly African American students. A three-track summer internship program--a result of that collaboration--has since been expanded to partnerships with other minority and majority universities throughout Texas. In 1998, for example, 108 undergraduate students from these universities (and 40 other universities nationwide) participated in research, professional, and administrative summer internships at UT-Houston. The InterCon network also has partnerships with K-12 schools. UT-Houston works with inner-city, suburban, and rural school districts to develop education models that can be transferred throughout the state. The partnerships deal with helping to teach basic academic skills and computer literacy, improve science-related instruction, meet demands for health promotion materials and information for school-initiated health and wellness programs, and develop distance-learning paradigms. UT-Houston views InterCon as a program helping Texas institutions to engage and adapt to the socioeconomic factors, demographic changes, and technology explosion that currently challenge public education.
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Affiliation(s)
- G A Castro
- University of Texas-Houston Health Science Center, USA
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Saylor B, Booker J, Hamilton J, Klose K. Methodological issues in evaluating a culture-based substance abuse treatment program in the Kuskokwim Delta, Alaska. Int J Circumpolar Health 1999; 57 Suppl 1:485-8. [PMID: 10093329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
This paper presents a rationale for using videotape records in evaluation research. Although videotaping is commonly used in ethnographic and sociometric analysis, the evaluation literature does not show the application of these recording techniques to program evaluations. The authors outline a model for exploring the effectiveness of video in qualitative program evaluation.
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Affiliation(s)
- B Saylor
- Institute of Circumpolar Health Studies, University of Alaska Anchorage, USA
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Spring M, McQuater R, Swift K, Dale B, Booker J. The use of quality tools and techniques in product introduction: an assessment methodology. ACTA ACUST UNITED AC 1998. [DOI: 10.1108/09544789810197855] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Reap EA, Roof K, Maynor K, Borrero M, Booker J, Cohen PL. Radiation and stress-induced apoptosis: a role for Fas/Fas ligand interactions. Proc Natl Acad Sci U S A 1997; 94:5750-5. [PMID: 9159145 PMCID: PMC20851 DOI: 10.1073/pnas.94.11.5750] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The lpr gene encodes a defective form of Fas, a cell surface protein that mediates apoptosis. This defect blocks apoptotic deletion of autoreactive T and B cells, leading to lymphoproliferation and lupus-like autoantibody production. The effects of the lpr Fas mutation on other kinds of physiologically relevant apoptosis are largely undocumented. To assess whether some of the apoptosis known to occur after ionizing radiation might be mediated by Fas/Fas ligand (FasL) interactions, we quantitated in vitro apoptosis by flow cytometry measurement of DNA content in splenic T and B cells from irradiated 5- to 8-month-old B6/lpr mice. Total apoptosis of both lpr and control cells was substantial after treatment; however there was a significant difference between B6 (73%) and lpr (25%) lymphocyte apoptosis. Thy1, CD4, CD8, and IgM cells from lpr showed much lower levels of apoptosis than control cells after irradiation. Apoptosis induced by heat shock was also impaired in lpr. The finding that gamma-irradiation increased Fas expression on B6 cells and that irradiation-induced apoptosis could be blocked with a Fas-Fc fusion protein further supported the possible involvement of Fas in this form of apoptosis. Fas/FasL interactions may thus play an important role in identifying and eliminating damaged cells after gamma-irradiation and other forms of injury.
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Affiliation(s)
- E A Reap
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599-7280, USA
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Nelson KD, Zhao W, Brown LD, Kuo J, Che J, Liu X, Klemperer SL, Makovsky Y, Meissner R, Mechie J, Kind R, Wenzel F, Ni J, Nabelek J, Leshou C, Tan H, Wei W, Jones AG, Booker J, Unsworth M, Kidd WSF, Hauck M, Alsdorf D, Ross A, Cogan M, Wu C, Sandvol E, Edwards M. Partially Molten Middle Crust Beneath Southern Tibet: Synthesis of Project INDEPTH Results. Science 1996; 274:1684-8. [PMID: 8939851 DOI: 10.1126/science.274.5293.1684] [Citation(s) in RCA: 921] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INDEPTH geophysical and geological observations imply that a partially molten midcrustal layer exists beneath southern Tibet. This partially molten layer has been produced by crustal thickening and behaves as a fluid on the time scale of Himalayan deformation. It is confined on the south by the structurally imbricated Indian crust underlying the Tethyan and High Himalaya and is underlain, apparently, by a stiff Indian mantle lid. The results suggest that during Neogene time the underthrusting Indian crust has acted as a plunger, displacing the molten middle crust to the north while at the same time contributing to this layer by melting and ductile flow. Viewed broadly, the Neogene evolution of the Himalaya is essentially a record of the southward extrusion of the partially molten middle crust underlying southern Tibet.
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Affiliation(s)
- KD Nelson
- K. D. Nelson, M. Cogan, C. Wu, Department of Earth Sciences, Syracuse University, Syracuse, NY 13244, USA. W. Zhao, J. Che, X. Liu, Chinese Academy of Geological Sciences, Beijing 100037, China. L. D. Brown, M. Hauck, D. Alsdorf, A. Ross, Institute for the Study of the Continents, Cornell University, Ithaca, NY 14853, USA. J. Kuo, Lamont Doherty Geological Observatory, Palisades, NY, 10964, USA. S. L. Klemperer and Y. Makovsky, Department of Geophysics, Stanford University, Stanford, CA 94305, USA. R. Meissner, Institut fur Geophysik, Christian-Albrechts-Universitaet zu Kiel, 24098 Kiel, Germany. J. Mechie and R. Kind, GeoForschungsZentrum Potsdam (GFZ), 14473 Potsdam, Germany. F. Wenzel, Geophysikalisches Institut, Universitaet Karlsruhe, 76187 Karlsruhe, Germany. J. Ni and E. Sandvol, Department of Physics, New Mexico State University, Las Cruces, NM 88003, USA. J. Nabelek, College of Oceanography, Oregon State University, Corvallis, OR 97331, USA. L. Chen, H. Tan, W. Wei, China University of Geosciences, Beijing, China. A. G. Jones, Geological Survey of Canada, 1 Observatory Crescent, Ottawa, Ontario, Canada. J. Booker and M. Unsworth, Geophysics Program, University of Washington, Seattle, WA 98195, USA. W. S. F. Kidd and M. Edwards, Department of Geosciences, SUNY-Albany, Albany, NY 12222, USA
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Abstract
Repeated hospitalizations result in high costs and may occur as a result of patient errors in their medication regimen. To reduce rehospitalizations (hospitalizations within 31 days of the previous discharge), health care professionals have turned to the discharge planning process. Using Orem's theory of self-care, a medication discharge planning program was developed to provide instruction on the requisites necessary for medication self-care. The purpose of this pilot study was to examine the effects of this program on readmissions within 31 days. Five nurses implemented the program for 54 patients with an admitting diagnosis of congestive heart failure. These patients were alternately assigned to a control or an experimental group. The experimental group received the medication discharge planning program. The control group received the usual informal discharge planning provided on the nursing unit. Eight (28.6%) of the 28 patients in the control group were readmitted within 31 days of the previous discharge. Two (7.7%) of the 26 patients in the experimental group were readmitted within 31 days. These results showed a statistically significant difference using Fisher's Exact Test (p = .05). Those receiving the medication discharge planning program were less likely to be readmitted, suggesting the importance of a medication discharge planning program.
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Hintner H, Booker J, Ashworth J, Auböck J, Pepys MB, Breathnach SM. Amyloid P component binds to keratin bodies in human skin and to isolated keratin filament aggregates in vitro. J Invest Dermatol 1988; 91:22-8. [PMID: 2455001 DOI: 10.1111/1523-1747.ep12463283] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Dermal keratin bodies, consisting mainly of keratin intermediate filament aggregates (KIFA) coated with IgM anti-KIF autoantibodies, are present in normal human skin and occur in increased quantities in certain skin diseases. Keratin bodies are normally rapidly removed, but in primary localized cutaneous amyloidosis (PLCA) they are converted by an unknown mechanism to amyloid. Amyloid P component (AP), a glycoprotein identical to, and derived from, the normal plasma protein serum amyloid P component (SAP), is present in all forms of amyloid including PLCA. We investigated the interaction between SAP, keratin bodies, and KIFA. Immunofluorescence staining of normal skin using fluoresceinated anti-SAP and rhodamine-conjugated anti-IgM, or AE-1/AE-3 anti-keratin antibodies followed by Texas Red-conjugated anti-mouse immunoglobulin, showed that 52% +/- 4 (mean +/- sem, n = 6) of keratin bodies bound anti-SAP. Similar findings were present in a biopsy from a patient with lichen planus. Isolated KIFA, prepared by 8M urea extraction of normal human epidermis or cultured keratinocytes, were preincubated with normal human serum as a source of SAP and then stained with fluoresceinated anti-SAP. Bright fluorescence seen when the incubation medium contained Ca++ was absent in the presence of ethylenediamine tetraacetic acid. Specific Ca++-dependent binding of SAP to KIFA was confirmed using immunoblotting. Binding of SAP to KIFA did not prevent their degradation following exposure to trypsin or alpha-chymotrypsin. Similarly, partial enzymatic digestion of KIFA did not abrogate their ability to bind SAP. Our findings, that SAP is associated with keratin bodies in skin and exhibits Ca++-dependent binding to KIFA in vitro, identify keratin filaments as a newly recognized ligand for SAP.
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Affiliation(s)
- H Hintner
- Department of Medicine, (Dermatology), Charing Cross and Westminister Medical School, London, U.K
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Abstract
We have investigated the mechanisms by which topical corticosteroids modulate cutaneous immune reactions in man. Volunteers applied clobetasone butyrate 0.05% (Eumovate; EV), betamethasone valerate 0.1% (Betnovate; BV), clobetasol propionate 0.05% (Dermovate; DV), and control vehicles twice daily to forearm skin for 7 days. Steroid therapy significantly decreased the number of HLA-DR/T6 (CD1a) positive Langerhans cells (LCs) per mm2 in suction blister-derived epidermal sheets, expressed as a mean percentage of controls, as follows: EV 69.2%; BV 67.3%; DV 37.8%. LC antigen presenting capacity was determined in the allogeneic and autologous epidermal cell-lymphocyte reactions. The LC-dependent allostimulatory capacity of epidermal cells, expressed as a mean percentage of controls, was also significantly reduced by steroid therapy: EV 45.1%; BV 41.9%; DV 23.4%. Following therapy with clobetasol propionate 0.05%, the capacity of epidermal cells to present tetanus toxoid to, and to augment concanavalin A mediated lymphocyte stimulation of, autologous lymphocytes was reduced to 33.6% and 19.7% respectively of controls. Depression of epidermal cell allostimulatory capacity was not the result of a steroid-induced decrease in the production of epidermal cell-derived thymocyte activating factor (ETAF)/interleukin 1 by keratinocytes, since it could not be reversed by addition of exogenous interleukin 1. Indomethacin, added to block any potential prostaglandin synthesis during the culture period, did not restore the allostimulatory capacity of epidermal cells from steroid-treated sites. Addition of epidermal cells from DV-treated sites depressed the capacity of control epidermal cells to stimulate lymphocytes in the allogeneic epidermal-lymphocyte reaction. Our results demonstrate that the anti-inflammatory action of topical corticosteroids in man is associated not only with a reduction in the number of HLA-DR/T6 positive LCs, but also with a marked decrease in Langerhans cell-dependent T lymphocyte activation. The effects of the different steroids on both of these parameters correlated with their potency as determined in the standard occlusive vasoconstrictor assay. Topical corticosteroids are widely used for the treatment of inflammatory skin disorders, and inhibit not only the elicitation phase, but also the induction phase, of allergic contact dermatitis reactions.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- J Ashworth
- Department of Medicine (Dermatology), Charing Cross and Westminster Medical School, London, U.K
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Booker J. Degradation products of irradiated haloperidol: implications for the development of an implantible delivery system. Pharmazie 1988; 43:31-2. [PMID: 3375298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Haloperidol was chosen as a model compound to determine whether the degradation products created by sterilizing dose of gamma radiation would contaminate an implantible delivery device and be hazardous to the health of the person using it. Acrolein, chlorobenzene, and several other products were identified among the degradation products. They were quantitated and evaluated as being potentially dangerous. It is recommended that the development protocol for a radiation-sterilized, implantible drug include the identification and evaluation of the degradation products.
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Affiliation(s)
- J Booker
- Analytical Research Laboratory, Kimberly-Clark Corporation, Neenah, Wisconsin
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Shore AC, Booker J, Sagnella GA, Markandu ND, MacGregor GA. Serum ionized calcium and pH: effects of blood storage, some physiological influences and a comparison between normotensive and hypertensive subjects. J Hypertens 1987; 5:499-505. [PMID: 3668250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effects on serum ionized calcium (ICa) and pH of different storage conditions of blood or serum, and of physiological influences such as over-ventilation, food intake and dietary sodium intake have been investigated. Temperature and time-related changes in ICa occurred with storage and were minimized by immediate separation of serum and storage at 4 degrees C, (6 h or less). Elevation of serum ICa and a fall in pH accompanied increased salt intake; over-ventilation induced an elevation of serum pH and a reduction in ICa. Day-to-day intra-individual variation of ICa was 0.93%. We proceeded to examine a group of age-, sex- and race-matched hypertensive and normotensive subjects under standardized conditions designed to minimize such technical and physiological artefacts. ICa was not significantly different in the two groups; however, serum pH was significantly elevated in the hypertensive group. In the combined group of normotensive and hypertensive subjects, serum pH was significantly correlated with blood pressure. Exclusion of the black subjects from the analysis did not alter the findings.
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Affiliation(s)
- A C Shore
- Department of Medicine, Charing Cross and Westminster Medical School, London, UK
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Booker J, Morris N, Huang CY. Cerebral radionuclide scintigraphy in the stroke syndrome. Med J Aust 1978; 1:625-30. [PMID: 683080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The cerebral scans of 365 patients with the stroke syndrome were reviewed retrospectively over a 30-month period. Positive static studies occurred in 140 patients )38%), of which 73 (52%) had an associated reduction of flow to the affected hemisphere on the dynamic study. Positive dynamic studies alone accurred in 69 patients (19%), increasing the positive yield by 50%. Dynamic studies also differentiate extracranial (carotid) occlusion from intracranial vascular occlusion, and may contribute to prognosis and management. Infarction in the middle cerebral artery territory is five times as common as infarction in any other arterial territory. An unexpected finding was the high incidence (5%) of watershed infarctions. These are more common than posterior cerebral artery strokes (4%), and anterior cerebral artery strokes (1%). When patients with vertebrobasilar and lacunar strokes, and those scanned within one week or after six weeks from the onset of symptoms are excluded, the positive yield was 54% for static studies, and 67% over all.
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Booker J, Vansant JH. The changing status of the emergency room. Va Med Mon (1918) 1969; 96:397-400. [PMID: 5790721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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