Converting an integrated hospital formulary into an object-oriented database representation

Controlled Medical Vocabularies (CMVs) have proven to be extremely useful in their support of the tasks of information sharing and integration, communication among various software applications, and decision support. Modeling a CMV as an Object-Oriented Database (OODB) provides additional benefits such as increased support for vocabulary comprehension and flexible access. In this paper, we describe the process of modeling and converting an existing integrated hospital formulary (i.e., set of pharmacological concepts) into an equivalent OODB representation, which, in general, we refer to as an Object-Oriented Healthcare Vocabulary Repository (OOHVR). The source for our example OOHVR is a formulary provided by the Connecticut Healthcare Research and Education Foundation (CHREF). Utilizing this source formulary together with the semantic hierarchy composed of major and minor drug classes defined as part of the National Drug Code (NDC) directory, we constructed a CMV that was eventually converted into its OOHVR form (the CHREF-OOHVR). The actual conversion step was carried out automatically by a program, called the OOHVR Generator, that we have developed. At present, the CHREF-OOHVR is running on top of ONTOS, a commercial OODB management system, and is accessible on the Web.

[Effects of blocking CD18-mediated leukocyte adhesion on the survival of the island flap]

OBJECTIVE

This study was to investigate the role of leukocyte and leukocyte adhesion in tissue injury from ischemia and reperfusion.

METHODS

The experiment utilized the monoclonal antibody (mAb) directed to the leukocyte adhesion glycoprotein CD18 to block leukocyte adhesion and aggregation in an island flap model in rats. Tissue content of myeloperoxidase (MPO) and malondialdehyde (MDA) were detected after transient treatment with either saline or mAb directed to CD18. Flap survival was assessed 7 days afterwards.

RESULTS

The content of both MPO and MDA was significantly increased with 8 h ischemia and 1 h reperfusion of the flap. The treatment with anti-CD18 mAb significantly decreased the levels of MPO and MDA and also significantly improved the survival of flaps compared with the saline-treated controls.

CONCLUSION

CD18-mediated leukocyte adhesion plays an important role in tissue injury from ischemia and reperfusion. Blocking leukocyte adhesion can attenuate leukocyte-mediated injury, providing protective effects on island flaps.

Contrasting roles for symmetrically disposed beta-turns in the folding of a small protein

To investigate the role of turns in protein folding, we have characterized the effects of combinatorial and site-directed mutations in the two beta-turns of peptostreptococcal protein L on folding thermodynamics and kinetics. Sequences of folded variants recovered from combinatorial libraries using a phase display selection method were considerably more variable in the second turn than in the first turn. These combinatorial mutants as well as strategically placed point mutants in the two turns had a similar range of thermodynamic stabilities, but strikingly different folding kinetics. A glycine to alanine substitution in the second beta-turn increased the rate of unfolding more than tenfold but had little effect on the rate of folding, while mutation of a symmetrically disposed glycine residue in the first turn had little effect on unfolding but slowed the rate of folding nearly tenfold. These results demonstrate that the role of beta-turns in protein folding is strongly context-dependent, and suggests that the first turn is formed and the second turn disrupted in the folding transition state.

Developmental changes in the effect of acidosis on contraction, intracellular pH, and calcium in the rabbit mesenteric small artery

The purpose of the present study was to determine developmental changes in the effect of respiratory acidosis on vascular smooth muscle contraction. Vessel diameter, intracellular pH (pHi), and calcium concentration ([Ca]i) were measured in a cannulated preparation of the small mesenteric artery of newborn and adult rabbits. In the artery precontracted by high KCl, acidosis caused a vasorelaxation both in the newborn and the adult; the vasorelaxation was greater in the newborn than in the adult. The fura-2 fluorescence ratio, an indicator of [Ca]i, decreased transiently during acidosis and the decrease was similar in the two age groups. In the artery precontracted by norepinephrine, acidosis caused a transient vasoconstriction in the adult and a vasorelaxation in the newborn. In these vessels, the fura-2 fluorescence ratio increased transiently during acidosis; the increase was similar in the two groups. Upon induction of acidosis, pHi fell rapidly in the artery precontracted by norepinephrine or high KCl, and the depression of pHi was similar in the two groups. In the skinned smooth muscle preparation, a tension-[Ca] relationship curve at pH 7.1 was not significantly different from that at pH 6.8 in the adult. In the newborn, the tension-[Ca] curve at pH 6.8 was shifted to the right, compared with that at pH 7.1. These data suggest that the vasorelaxant effect of respiratory acidosis in the premature vessel is greater than in the adult. The greater vasorelaxation in the newborn cannot be explained by the age-related difference in pHi or [Ca]i during acidosis. The greater sensitivity of myofibrils to low pHi in the newborn may, at least in part, be responsible for the greater vasorelaxation in this age group.

Cardioprotective efficacy of ischemic preconditioning on long-term myocardial ischemia

This study was designed to assess whether the protective effect of ischemic preconditioning can be adapted for myocardium undergoing 6 h of no-flow ischemia. Twelve isolated rat hearts were either perfused with oxygen-bicarbonated Krebs-Henseleit buffer in the Langendorff mode for 35 min (n=6), or perfused in the same way for 20 min, following 5 min of global normothermic ischemia and 100 min of buffer-perfusion (n=6). The 12 hearts were then preserved for 6 h in HTK solution at 4 degrees C, followed by 30 min of reperfusion. Recovery of cardiac function, metabolic activity and intracellular free calcium concentration were compared between the two groups. After 6 h ischemia, the hearts that underwent preconditioning showed better recovery of left ventricular developed pressure (P<0.01), a lower end-diastolic pressure level (P<0.05), less creatine kinase leakage and a lower calcium concentration. There was no statistical difference in the recovery rate of coronary flow and leakage rate of LDH between the two groups. In conclusion, this experiment demonstrates that ischemic preconditioning improved myocardial functional recovery after 6 h of hypothermic ischemic preservation in the isolated rat heart. Preconditioning might be a potential mechanism for preserving the heart against long-term ischemia/reperfusion injury.

Partitioning a vocabulary's IS-A hierarchy into trees

Controlled medical vocabularies are useful in application areas such as medical information-systems and decision-support. However, such vocabularies are large and complex, and working with them can be daunting. It is important to provide a means for orienting users to the vocabulary's contents. This paper introduces a methodology for partitioning a vocabulary into small, meaningful pieces. The partitioning is done with respect to the vocabulary's IS-A hierarchy. The methodology, based on a set of rules for refining the IS-A hierarchy, is a process carried out by a user in conjunction with the computer. The methodology is demonstrated on a complex portion of a vocabulary.

An interleukin 4 (IL-4)-independent pathway for CD4+ T cell IL-4 production is revealed in IL-4 receptor-deficient mice

IL-4 receptor alpha chain (IL-4Ralpha)-deficient mice were generated by gene-targeting in BALB/c embryonic stem cells. Mutant mice showed a loss of IL-4 signal transduction and functional activity. The lack of IL-4Ralpha resulted in markedly diminished, but not absent, TH2 responses after infection with the helminthic parasite Nippostrongylus brasiliensis. CD4+, CD62L-high, and CD62L-low T cell populations from uninfected IL-4Ralpha-/- mice were isolated by cell sorting. Upon primary stimulation by T cell receptor cross-linkage, the CD62L-low, but not the CD62L-high, cells secreted considerable amounts of IL-4, which was strikingly enhanced upon 4-day culture with anti-CD3 in the presence or absence of IL-4. CD62L-low cells isolated from IL-4Ralpha-/-, beta2-microglobulin-/- double homozygous mice produced less IL-4 than did either IL-4Ralpha-/- or wild-type mice. These results indicate that an IL-4-independent, beta2-microglobulin-dependent pathway exists through which the CD62L-low CD4+ population has acquired IL-4-producing capacity in vivo, strongly suggesting that these cells are NK T cells.

Mice lacking a functional chk gene have no apparent defects in the hematopoietic system

Non-receptor tyrosine kinase Chk has been implicated in hematopoietic development. To study the function of Chk in vivo, we have generated chk-deficient mice using gene targeting. Overall development of mice homozygous for this mutation was apparently normal. Blood counts, FACS analysis of hematopoietic cell populations, CFU-C and CAFC assays showed no significant difference between wild type and mutant animals. Thus, the dispensability of Chk for mouse development and hematopoiesis suggests that its function may be redundant in vivo, and most likely be compensated by activity of a closely related protein tyrosine kinase Csk.

[Observation on electrogastrogram changes during parallel swing stimulation]

In order to study the relationship between cutaneous electrogastrogram (EGG) and nausea syndrome of the motion sickness, power spectrum analysis is used to analyze EGG recorded during motion sickness evoked by the parallel swing in 32 healthy men. 20 subjects showed a shift of Period Dominant Frequency (PDF) of EGG from Three CPM (2.40-3.70cpm) to Tachygastria (3.70-10.00cpm). PDF, the percentage of power of Tachygastria wave and Dominant Frequency Instability Coefficient significantly increased (P < 0.01). The incidences of nausea syndrome was obvious at the moment after swing. The result showed that EGG may be used for testing nausea symptoms of motion sickness.

1-Acetyl-3-hydroxyadamantane and 1-carboxy-3-hydroxyadamantane

The crystal structures of the adamantane derivatives, 1-acetyl-3-adamantanol, C12H18O2, (4), and 3-hydroxyadamantane-1-carboxylic acid, C11H16O3, (5), have been determined by X-ray diffraction. Both structures show extensive intermolecular hydrogen bonding involving the hydroxyl and acetyl groups in compound (4), and the hydroxyl and carboxyl groups in compound (5).

Heterogeneous nuclear RNP protein A1-arginine methylation during HCT-48 cell cycle

Protein methylase I (protein-arginine N-methyltransferase) was examined in HCT-48 cells, synchronized by serum deprivation and hydroxyurea treatment. The enzyme activity to methylate the added hnRNP protein A1 increased about 2-fold from G0 to S phase, and then decreased during G2/M phase. The enzymatically [methyl-3H]-labeled hnRNP protein A1 was identified by SDS-PAGE/fluorography, and the products were identified as NG-monomethylarginine and NG,NG-dimethyl-(asymmetric)arginines by HPLC. Among endogenous proteins, the 20-kDa species in the extract was most intensely [methyl-3H]-labeled. This 20-kDa methylation was markedly inhibited by the addition of exogenous hnRNP protein A1, indicating that these two substrates compete for the same protein methylase. The possible role of this post-translational modification has been discussed.

[Studies on determination of p-aminophenol and its related compounds prepared with catalytic hydrogenation by reversed-phase high performance liquid chromatography]

Catalytic hydrogenation of nitrobenzene with supported palladium catalyst is a new method to produce p-aminophenol. p-Aminophenol, aniline and 4,4'-diaminodiphenyl ether obtained from this method were determined by reversed phase high performance liquid chromatography. The factors, e.g., concentration of methanol, pH and ionic strength which could affect separation efficiency were studied. UV spectra of p-aminophenol, aniline and 4,4'-diaminodiphenyl ether were recorded. Good separation was performed by using a 100 mm x 4.6 mm column with 5 microm Hypersil ODS, a mixture of 60% aqueous 8.0 mmol/L KH2PO4 buffered to 6.5 with 4.0 mmol/L Na2HPO4 and 40% methanol as mobile phase at a flow rate of 1.0 mL/min, and UV spectrophotometric detector at 232 nm wavelength. The calibration curves of p-aminophenol, aniline and 4,4'-diaminodiphenyl ether have good linearity over concentration range of 5-250, 5-150 and 0.2-120 mg/L, respectively. Minimum detectable limits at a signal-to-noise ratio of 2 were 0.1, 0.6 and 0.6 ng. This method has been applied to analysis of the reaction products of ultrasonic catalytic hydrogenation and industrial samples with good results and reproducibility.

Characterization of two SHP-2-associated binding proteins and potential substrates in hematopoietic cells

Multiple studies have demonstrated an important role for the Src homology 2-containing tyrosine phosphatase 2 (SHP-2) in receptor tyrosine kinase-regulated cell proliferation and differentiation. Recent studies have identified potential SHP-2 substrates which mediate these effects. SHP-2 also is implicated in several cytokine receptor signaling pathways and in Bcr-Abl transformation. However, its precise role and targets in normal and abnormal hematopoietic cells remain to be determined. We identified two novel tyrosyl-phosphorylated proteins associated with SHP-2 in hematopoietic cells. The first, a 97-kDa cytosolic protein (p97), associates inducibly with SHP-2 upon cytokine stimulation and constitutively in Bcr-Abl-transformed cells. In contrast, p135, a 135-kDa transmembrane glycoprotein, forms a distinct complex with SHP-2, independent of cytokine stimulation or Bcr-Abl transformation. Far Western analysis reveals that SHP-2, via its Src homology 2 domains, can interact directly with either protein. In vitro dephosphorylation experiments, as well as transient transfection studies using wild type and mutant SHP-2 constructs, suggest that p97 and p135 also are SHP-2 substrates. Our results indicate that SHP-2 forms at least two separate complexes in hematopoietic cells and point to new potential SHP-2 targets.

[Comparison of evaluation methods on changes of facial microcirculation during induction of motion sickness]

In order to increase the accuracy of motion sickness grading criteria, infrared thermography and Laser Doppler microcirculation blood-flow detector were used in 60 healthy male individuals: before, immediately, and 20 min after paralleled-swing stimulation. Facial skin temperature and microvessel blood-flow were recorded. The results showed that facial skin temperature and blood flow in facial microvessels fell together with the appearance of pallor. However, the degree of pallor observed with naked eye was inconsistent with that found by thermography or facial blood flow. It suggests that the accuracy of grading might be improved with the use of thermography or measurement of facial microvessel blood flow.

Kinetics of folding of the IgG binding domain of peptostreptococcal protein L

The kinetics of folding of a tryptophan containing mutant of the IgG binding domain of protein L were characterized using stopped-flow circular dichroism, stopped-flow fluorescence, and HD exchange coupled with high-resolution mass spectrometry. Both the thermodynamics and kinetics of folding fit well to a simple two-state model: (1) Guanidine induced equilibrium denaturation transitions measured by fluorescence and circular dichroism were virtually superimposable. (2) The kinetics of folding/unfolding were single exponential under all conditions examined, and the rate constants obtained using all probes were similar. (3) Mass spectra from pulsed HD exchange refolding experiments showed that a species with very little protection from exchange is converted to a fully protected species (the native state) at a rate very similar to that of the overall change in tryptophan fluorescence; no intervening partially protected species were observed. (4) Rate constants (in H2O) and m values for folding and unfolding determined by fitting observed relaxation rates obtained over a broad range of denaturant concentrations to a two-state model were consistent with the equilibrium parameters deltaG and m: -RT ln(k(u)/k(f))/deltaG(U)H2O = 1.02; (m(u) + m(f))/m = 1.08. In contrast to results with a number of other proteins, there was no deviation from linearity in plots of ln k(obs) versus guanidine at low guanidine concentrations, both in the presence and absence of 0.4 M Na2SO4, suggesting that significantly stabilized intermediates do not accumulate during folding. Although all of the change in fluorescence signal during folding in phosphate buffer was accounted for by the simple exponential describing the overall folding reaction, fluorescence-quenching experiments using sodium iodide revealed a small reduction in the extent of quenching of the protein within the first two milliseconds after initiation of refolding in low concentrations of guanidine, suggesting a partial collapse of the unfolded chain may occur under these conditions. Comparison with results on the structurally and functionally similar IgG binding domain of streptococcal protein G show intriguing differences in the folding of the two proteins.

[Observation of chromosome aberration and micronucleus formation in peripheral blood lymphocytes among cigarette smokers]

Using two interrelated observation indices--chromosomal aberration and micronucleus analysis in peripheral blood lymphocytes to reflect damages of genetic material, were used to observe the status of genetic material damage in male smokers at the same time. The results showed that there were significant increases in hyperpolid cell rate, chromatid and chromosome aberration rates, total aberant cell rate and frequency of micronucleated cells as well as micronucleus in smoking group when compared to non-smoking group. This findings showed that cigarette smoking is one of the important mutagenic factors which caused damage to human genetic materials.

Effect of acidosis on contraction, intracellular pH, and calcium in the newborn and adult rabbit aorta

This study investigated the effect of acidosis on intracellular pH (pHi), intracellular calcium concentration ([Ca]i), and vascular contraction in the aorta of the newborn and adult rabbit. Isometric tension, pHi, and [Ca]i were measured in an isolated ring preparation. After the vascular contraction was induced with 50mM KC1, the effect of respiratory acidosis produced by elevation of PCO2 was studied. Respiratory acidosis caused a transient depression followed by a recovery of contractile tension. The decrease in developed tension was greater in the newborn than in the adult. The decrease in pHi during acidosis was similar in the two age groups. [Ca]i increased during acidosis and the increase was greater in the newborn than in the adult. These data show that the vasorelaxant effect of acidosis in the newborn aorta is greater than that in the adult aorta. The greater vasodilation in the newborn cannot be explained by the difference in pHi or [Ca]i.

[Study of the effects of pulse magnetic fields on hemorrheology of human body]

The results show that middle shear specific viscosity and reductive viscosity (P<0.05), low shear specific viscosity and reductive viscosity of whole blood (P<0.01) decreased significantly in experimental group after 9-day of pulse magnetic fields, comparing with control group, high shear specific viscosity, low shear reductive viscosity (P<0.05) and middle and low shear specific viscosity (P<0.01) of whole blood in experimental group were lower after exposed than before exposed to pulse magnetic fields. The results suggest that the pulse magnetic fields may reduce specific and reductive viscosity of whole blood in human body.

Developmental changes in the contractile system of the mesenteric small artery of rabbit

This study investigated developmental changes in the contractile system of the mesenteric small arteries of the rabbit. Arteries about 1 mm in length and 100-250 microns in internal diameter were dissected out from the mesenteric bed of the fetus (29 d of gestation), newborn (3-5 d old), and adult rabbit. Vascular contraction was induced by high KCl concentration, and contractile force was measured using a tension transducer. The sensitivity of vascular contraction to high KCl was similar in the three age groups. To determine the role of Ca influx across the sarcolemma in vascular contraction, the vasorelaxant effect of diltiazem was studied in the artery precontracted with high KCl concentration. The vasorelaxant effect of diltiazem in the fetus and newborn was less than in the adult. To estimate the size of the intracellular Ca pool, caffeine-induced and noradrenaline-induced contraction were measured in the Ca- and Na-free solution. In the fetus and newborn, both the caffeine-induced contraction and noradrenaline-induced contraction were greater than in the adult. The ultrastructural study showed that the endoplasmic reticulum was abundant in the fetus and newborn, and it was scarce in the adult. These data indicate that the dependency of vascular contraction on Ca influx across the sarcolemma increases and the intracellular Ca store decreases with development in the mesenteric resistance arteries.

H-ras transfection of the rat kidney cell line NRK-52E results in increased induction of c-fos, c-jun and hsp70 following sulofenur treatment

The effect of the antineoplastic drug sulofenur on the induction of the immediate-early genes (IEG) c-fos and c-jun and the stress gene hsp70 was compared in the rat kidney epithelial-like cell line NRK-52E and a derivative H-ras-transfected (H/1.2NRK-52E) cell line. Fold induction for each gene after sulofenur (500 microM) treatment was greater in H/1.2NRK-52E. The maximum increases for NRK-2E and H/1.2NRK-52E were as follows: c-fos, approximately 10-fold and approximately 18-fold; c-jun, approximately 2.5-fold and approximately 3.6-fold; hsp70, approximately 13-fold and approximately 30-fold. In cells loaded with EGTA/AM or treated in low or no Ca2+ HBSS, c-fos induction was reduced similarly in both cell types. However, inhibition of protein kinases with staurosporin and calphostin C reduced c-fos by 80% in NRK-52E but by only 10-20% in H/1.2NRK.52E. These results indicate that sulofenur-induced IEG elevation is Ca(2+)-dependent and that the requirement for protein kinase C activation is bypassed in H-ras-transfected cells.

Effect of acidosis on contraction, intracellular pH and calcium in the rabbit mesenteric small artery

The purpose of the present study was to determine the effect of various types of acidosis on vessel diameter, intracellular pH (pHi), and calcium concentration ([Ca2+]i) in a cannulated preparation of the mesenteric arteriole of the rabbit. The effect of acidosis on vessel contraction was also studied in the wire-mounted preparation. In the cannulated preparation, pre-contracted by noradrenaline, hypercapnia caused vasoconstriction and increases in [Ca2+]i. In the wire-mounted preparation pre-contracted by either noradrenaline or high KCl, hypercapnia caused a transient vasoconstriction. In contrast, in the cannulated preparation pre-contracted by high KCl, hypercapnia caused a transient vasorelaxation and decreases in [Ca2+]i. Intracellular acidosis, induced by a NH4Cl prepulse, caused vasoconstriction and increases in [Ca2+]i even in the cannulated preparation pre-contracted by high KCl. The decrease in pHi during hypercapnia was similar to that observed after NH4Cl withdrawal. These data suggest that: (1) the effect of acidosis on vascular tone and [Ca2+]i is different depending upon the type of preparation and the mode of pre-activation, and (2) [Ca2+]i may, at least partly, regulate vascular contraction and relaxation during acidosis.

A clinical study on severe hydroa vacciniforme

OBJECTIVE

To describe a severe type of hydroa vacciniforme (HV) in order to provide basis for treatment and prevention of this disease.

METHODS

Nine cases of HV were collected in our outpatient department, and clinical and laboratory examinations were performed.

RESULTS

All the cases had erythemas, papules, bullae, erosions or ulcers on exposed sites, with recurrences, gradually resulting in deformation. Five patients suffered from hand deformation manifesting rigidity, flexor tetanus, or malposition of the first, second and third interphalangeal joints of hands. Two of the above mentioned patients manifested partial bone absorption of fingers. Five patients showed partial defect of auricle. Two patients showed saddle nose, and partial absorption of nasal cartilage. One patient displayed cicatricial contracture of lower lip, with incisor extrusion. Four patients showed opacity of cornea. Through laboratory examinations, porphyrinopathies were excluded. Phototests showed increased sensitivity to ultraviolet-A radiation (UVA).

CONCLUSIONS

Based on the clinical features and laboratory examinations, these patients were diagnosed as having severe HV. It is believed that this condition belongs to a disease spectrum induced by ultraviolet light. Our analysis suggests that for children with severe type of HV, preventive measures and therapeutic agents should be taken as soon as possible in order to avoid deterioration of the disease and malformations.