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Clarke F, Mcdonald E, Griffith L, Cook D, Mead M, Guyatt G, Rabbat C, Geerts W, Arnold D, Warkentin T, Crowther M. Crit Care 2004; 8:P125. [DOI: 10.1186/cc2592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mcmullin J, Mcdonald E, Clarke F, Jaeschke R, Gibson J, Cook D. Crit Care 2004; 8:P251. [DOI: 10.1186/cc2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lipton AM, McColl R, Cullum CM, Allen G, Ringe WK, Bonte FJ, McDonald E, Rubin CD. Differential activation on fMRI of monozygotic twins discordant for AD. Neurology 2003; 60:1713-6. [PMID: 12771278 DOI: 10.1212/01.wnl.0000063321.24058.3e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This is the first report of fMRI in monozygotic twins discordant for AD. FMRI brain activation patterns were examined during visuospatial and verbal working memory tasks. The affected twin had greater parietal involvement bilaterally during both working memory tasks and reduced left dorsolateral prefrontal cortex activity on the visuospatial memory task. Thus, fMRI may identify additional brain regions recruited in patients with AD to perform a given cognitive task.
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Mcdonald E, Landry F, Rabbat C, Boudreau C, Crowther M, Meade M, Geerts W, Cook D. Crit Care 2003; 7:P112. [DOI: 10.1186/cc2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Crowther MA, McDonald E, Johnston M, Cook D. Vitamin K deficiency and D-dimer levels in the intensive care unit: a prospective cohort study. Blood Coagul Fibrinolysis 2002; 13:49-52. [PMID: 11994567 DOI: 10.1097/00001721-200201000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients in the intensive care unit (ICU) are at risk for the development of vitamin K deficiency. We sought to determine the frequency of this deficiency by performing a prospective cohort study in which patients were screened for vitamin K deficiency on ICU admission and every other day thereafter. Vitamin K deficiency was diagnosed by a functional coagulation factor II to Echis factor II ratio < 0.70. Activity of the coagulation cascade was measured by D-dimer. In total, 40 patients were enrolled into the study. Seven of the patients had ratios < 0.70 on the day of admission to the ICU, and three patients developed ratios < 0.70. Thus, 10 of 40 patients (25%; 95% confidence interval, 12-38%) had vitamin K deficiency. Two patients developed coagulopathy, as indicated by an International Normalized Ratio of more than 1.4. D-dimer levels were elevated in 86 of 111 samples. We conclude that vitamin K deficiency is common among critically ill patients, particularly on admission to the ICU. Our findings suggest that additional clinical research is warranted to determine whether vitamin K supplementation on admission to the ICU reduces the risk of ICU-acquired vitamin K deficiency and its attendant complications over the course of the ICU stay.
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Fischer SJ, McDonald ES, Gross L, Windebank AJ. Alterations in cell cycle regulation underlie cisplatin induced apoptosis of dorsal root ganglion neurons in vivo. Neurobiol Dis 2001; 8:1027-35. [PMID: 11741398 DOI: 10.1006/nbdi.2001.0426] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cisplatin is used in the treatment of ovarian and testicular cancer. Twenty percent of patients cannot be optimally treated because of sensory neurotoxicity. Human and animal studies demonstrate that the dorsal root ganglion neuron is the primary target of drug injury. We have previously demonstrated that cisplatin causes neuronal apoptosis in vitro. We now report a reproducible animal model of cell death induced by cisplatin. Drug was administered for 1 or 2 cycles of 5 days separated by 5 days. Total dose administered was 0, 5, 7.5, 10, or 15 mg/kg. Ganglia from 34 animals were processed and examined using in situ hybridization for cyclin D1 messenger RNA and digoxigenin coupled TUNEL staining. Overall, 2.9 +/- 3.9% of neurons were TUNEL positive in treated rats compared with 0.2 +/- 0.3% in controls (P <.005). There was a strong positive correlation (r2 = 0.88; P = 0.018) between percentage of TUNEL stained DRG and cumulative dose of cisplatin. Two independent approaches to quantitation of in situ cyclin D1 hybridization were used; blinded grading by an observer and measurement of color density using digital image analysis. Both demonstrated dramatic upregulation of expression of cyclin D1 mRNA in treated compared with control rats. This demonstrates that apoptosis of neurons is preceded by aberrant reentry into G1 phase of the cell cycle in an animal model.
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MESH Headings
- Animals
- Antineoplastic Agents/toxicity
- Apoptosis/drug effects
- Apoptosis/genetics
- Caspase 3
- Caspases/metabolism
- Cell Cycle/drug effects
- Cell Cycle/physiology
- Cisplatin/toxicity
- Cyclin D1/drug effects
- Cyclin D1/genetics
- Cyclin D1/metabolism
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Female
- Ganglia, Spinal/drug effects
- Ganglia, Spinal/pathology
- Ganglia, Spinal/physiopathology
- Immunohistochemistry
- In Situ Hybridization
- In Situ Nick-End Labeling
- Nerve Degeneration/chemically induced
- Nerve Degeneration/genetics
- Nerve Degeneration/pathology
- Neurons, Afferent/drug effects
- Neurons, Afferent/pathology
- Neurotoxins/toxicity
- Pain Measurement/drug effects
- Peripheral Nervous System Diseases/chemically induced
- Peripheral Nervous System Diseases/genetics
- Peripheral Nervous System Diseases/pathology
- Platinum/blood
- Platinum/pharmacokinetics
- RNA, Messenger/drug effects
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Renal Insufficiency/chemically induced
- Up-Regulation/drug effects
- Up-Regulation/physiology
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Macdonald SJ, Dowle MD, Harrison LA, Spooner JE, Shah P, Johnson MR, Inglis GG, Clarke GD, Belton DJ, Smith RA, Molloy CR, Dixon M, Murkitt G, Godward RE, Skarzynski T, Singh OM, Kumar KA, Hodgson ST, McDonald E, Hardy GW, Finch H, Humphreys DC, Fleetwood G. Intracellular inhibition of human neutrophil elastase by orally active pyrrolidine-trans-lactams. Bioorg Med Chem Lett 2001; 11:243-6. [PMID: 11206469 DOI: 10.1016/s0960-894x(00)00632-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Described are the acylation binding of trans-lactam 1 to porcine pancreatic elastase, the selection of the SO2Me activating group for the lactam N which also confers metabolic stability in hamster liver microsomes, the introduction of aqueous solubility through the piperidine salt 9, the in vivo oral activity of 9 and its bioavailability, and the introduction of 9 as an intracellular neutrophil elastase inhibitor.
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Abstract
SUMMARY Although some aspects of New Zealand family law have been criticised as discriminatory, the New Zealand legal system has yet to be critically examined from a lesbian perspective. This article begins a development of lesbian legal theory for Aotearoa/New Zealand by analysing the contribution that the 1999 Law Commission study, Women's Access to Legal Services,has made to our knowledge about the impact of the law on lesbian relationships and communities.
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Cook D, Attia J, Weaver B, McDonald E, Meade M, Crowther M. Venous thromboembolic disease: an observational study in medical-surgical intensive care unit patients. J Crit Care 2000; 15:127-32. [PMID: 11138871 DOI: 10.1053/jcrc.2000.19224] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Acute and chronic illness, immobility, and procedural and pharmacologic interventions may predispose patients in the intensive care unit (ICU) to venous thromboembolic (VTE) disease. The purpose of this study was to observe potential risk factors and diagnostic tests for VTE, and prophylaxis against VTE in medical-surgical ICU patients. MATERIALS AND METHODS In a prospective observational study, 93 consecutive patients admitted to a mixed medical-surgical ICU were followed. We recorded demographics, admitting diagnoses, APACHE II score, VTE risk factors, antithrombotic, anticoagulant and thrombolytic agents, diagnostic tests for deep venous thrombosis (DVT) and pulmonary embolus (PE), and clinical outcomes. RESULTS Patients were 65.5 (15.5) years old with an APACHE II score of 21.1 (9.0); 44 (47.3%) were female. Admission diagnoses were medical (58, 67.4%) and surgical (35, 37.6%). The duration of ICU stay was 3 days (interquartile range: 1, 8.5 days) and the ICU mortality rate was 20.4% (19 of 93). We observed 8 VTE events among 5 of 93 patients (incidence 5.4% [0.8 to 10.0]); 2 patients had DVT and PE before admission, 1 had DVT as an admitting diagnosis, 1 had DVT on day 2 and PE on day 3, and 1 had PE on day 2. Over 804 ICU patient-days, 2 of 5 ultrasound examinations diagnosed DVT and 2 of 3 ventilation-perfusion lung scans diagnosed PE. Of 64 patients in whom heparin was not contraindicated and who were not anticoagulated, subcutaneous heparin prophylaxis was prescribed for 40 (62.5%) patients. ICU-acquired VTE risk factors were mechanical ventilation (odds ratio [OR] 1.56), immobility (OR 2.14), femoral venous catheter (OR 2.24), sedatives (OR 1.52), and paralytic drugs (OR 4.81), whereas VTE heparin prophylaxis (OR 0.08), aspirin (OR 0.42), and thromboembolic disease stockings (OR 0.63) were associated with a lower risk. Only warfarin (OR 0.07, P =.01) and intravenous heparin (OR 0.04, P<.01) were associated with a significantly decreased risk of VTE. CONCLUSIONS Several ICU-acquired risk factors for VTE were documented in this medical-surgical ICU. VTE prophylaxis was underprescribed, and VTE diagnostic tests were infrequent. Further research is required to determine the incidence, predisposing factors, attributable morbidity, mortality, and costs of VTE in medical-surgical ICU patients, the optimal diagnostic test strategies, and the most cost-effective approaches of prophylaxis.
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Miller JD, Urschel JD, Cox G, Olak J, Young JE, Kay JM, McDonald E. A randomized, controlled trial comparing thoracoscopy and limited thoracotomy for lung biopsy in interstitial lung disease. Ann Thorac Surg 2000; 70:1647-50. [PMID: 11093503 DOI: 10.1016/s0003-4975(00)01913-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lung biopsies are frequently needed to diagnose diffuse interstitial lung diseases. A prospective randomized, controlled trial comparing limited thoracotomy (open lung biopsy) and thoracoscopy for lung biopsy was done. METHODS Ambulatory patients with a clinical diagnosis of diffuse interstitial lung disease were randomized to thoracoscopy or limited thoracotomy. Data on postoperative pain, narcotic requirements, operating room time, adequacy of biopsy, duration of chest tube drainage, length of hospital stay, spirometry, and complications were collected. RESULTS A total of 42 randomized patients underwent lung biopsy (thoracoscopy 20, thoracotomy 22). The two study groups were comparable with respect to age, gender, corticosteroid use, and preoperative spirometry. Visual analog scale pain scores were nearly identical in the two groups (p = 0.397). Total morphine dose was 50.8 +/- 27.3 mg in the thoracoscopy group and 52.5 +/- 25.6 mg in the thoracotomy group (p = 0.86). Spirometry (FEV1) values in the two groups were not significantly different on postoperative days 1, 2, 14, and 28 (p = 0.665). Duration of operation was similar in both groups (thoracoscopy 40 +/- 30 minutes, thoracotomy 37 +/- 15 minutes; p = 0.67). The thoracoscopy and thoracotomy groups had equivalent duration of chest tube drainage (thoracoscopy 38 +/- 28 hours, thoracotomy 31 +/- 26 hours; p = 0.47) and length of hospital stay (thoracoscopy 77 +/- 82 hours, thoracotomy 69 +/- 55 hours; p = 0.72). Definitive pathologic diagnoses were made in all patients. CONCLUSIONS There is no clinical or statistical difference in outcomes for thoracoscopic and thoracotomy approaches. Both thoracoscopy and thoracotomy are acceptable procedures for diagnostic lung biopsy in diffuse interstitial lung disease.
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Marino C, McDonald E. Late onset hypersensitivity to sulfasalazine in a patient with ankylosing spondylitis: comment on the article by Paul et al. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 2000; 13:335; author reply 335. [PMID: 14635305 DOI: 10.1002/1529-0131(200010)13:5<335::aid-anr15>3.0.co;2-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Abstract
Neurotoxic injury to the nervous system produces neuronal death or distal axonal degeneration. Neurotoxin-induced demyelination is relatively rare in the peripheral and central nervous systems. Major advances have occurred in our understanding of the mechanisms of apoptotic cell death. The pathways leading to apoptosis offer many new approaches to neuroprotection.
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Pass M, Abu-Rabie S, Baxter A, Conroy R, Coote SJ, Craven AP, Finch H, Hindley S, Kelly HA, Lowdon AW, McDonald E, Mitchell WL, Pegg NA, Procopiou PA, Ramsden NG, Thomas R, Walker DA, Watson NS, Jhoti H, Mooney CJ, Tang CM, Thomas PJ, Parry S, Patel C. Thrombin inhibitors based on [5,5] trans-fused indane lactams. Bioorg Med Chem Lett 1999; 9:1657-62. [PMID: 10397495 DOI: 10.1016/s0960-894x(99)00244-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A series of trans-fused lactams containing the indane nucleus has been prepared. Compound 19 has much enhanced plasma stability compared with its lactone counterpart and shows appreciable in vitro anticoagulant activity.
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Pass M, Bolton RE, Coote SJ, Finch H, Hindley S, Lowdon A, McDonald E, McLaren J, Owen M, Pegg NA, Mooney CJ, Tang CM, Parry S, Patel C. Synthetic [5,5] trans-fused indane lactones as inhibitors of thrombin. Bioorg Med Chem Lett 1999; 9:431-6. [PMID: 10091697 DOI: 10.1016/s0960-894x(99)00002-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Synthesis of trans-fused lactones containing the indane nucleus has resulted in a series of potent acylating inhibitors of thrombin. As an example compound 11e has an apparent second order rate constant of 11 x 10(6) M(-1)sec(-1) for the inhibition of thrombin. The anticoagulant activity of these compounds is discussed.
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Miller JD, Malthaner RA, Goldsmith CH, Cox G, Higgins D, Stubbing D, Kitching A, Newman TE, McDonald E. Lung volume reduction for emphysema and the Canadian Lung Volume Reduction Surgery (CLVR) Project. Can Respir J 1999; 6:26-32. [PMID: 10202218 DOI: 10.1155/1999/817812] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To review the literature on the surgical treatment of emphysema and to present preliminary results from a pilot study of lung volume reduction (LVR) surgery. DESIGN Case series of consecutive patients referred for LVR surgery. Outcomes were quality of life, pulmonary function and exercise capacity. SETTING Two university-affiliated hospitals in Ontario. POPULATION STUDIED Patients between the ages of 40 and 75 years with emphysema who had severe airflow limitation, hyperinflation of the lungs and impaired quality of life. INTERVENTION Bilateral reductions with multiple wedge resections of the lung using a linear stapling device with bovine pericardial buttressing were completed via a median sternotomy. MAIN RESULTS Of 50 patients referred, 24 underwent LVR surgery. Mean age of the cohort was 63 years. Operative 30-day or in hospital mortality was 8%. Two other patients (8%) died from respiratory failure after LVR within the first year. Postoperative complications included prolonged air leaks (six of 24), tracheobronchitis (five of 24), mechanical ventilation (four of 24) and pneumonia (three of 24). Mean length of stay was 18 days (median 12 days). At one year, there was a sustained decrease in total lung capacity from 133% to 123% predicted. There were improvements in forced expiratory volume in 1 s, from 22% of predicted preoperatively to 32% postoperatively, and in 6 min walk performance, from 345 to 381 m. Improvements were also noted in the quality of life assessments. CONCLUSIONS Preliminary results suggest that LVR surgery is feasible and may improve the patient's quality of life, pulmonary function and exercise capacity. A randomized clinical trial comparing LVR plus the best medical management with the best medical management alone is currently underway to determine the effectiveness of LVR.
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Chen X, Kempf DJ, Sham HL, Green BE, Molla A, Korneyeva M, Vasavanonda S, Wideburg NE, Saldivar A, Marsh KC, McDonald E, Norbeck DW. Potent piperazine hydroxyethylamine HIV protease inhibitors containing novel P3 ligands. Bioorg Med Chem Lett 1998; 8:3531-6. [PMID: 9934466 DOI: 10.1016/s0960-894x(98)00653-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The 2-isopropyl thiazolyl group is a highly optimized P3 ligand for C2 symmetry-based HIV protease inhibitors, as exemplified in the drug ritonavir. Here we report that incorporation of this P3 ligand into a piperazine hydroxyethylamine series also yielded novel, highly potent inhibitors. In tissue culture assays, the presence of human serum was less deleterious to the activity of these inhibitors than to that of ritonavir. Furthermore, potent activity against ritonavir resistant HIV was observed.
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McDonald E, Marino C. Stopping progression to tophaceous gout. When and how to use urate-lowering therapy. Postgrad Med 1998; 104:117-20, 123-4, 127. [PMID: 9861261 DOI: 10.3810/pgm.1998.12.394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although the prevalence of tophaceous gout has decreased in the past few years, the disease still exists, and without accurate diagnosis and therapy, it can still result in destructive arthritis. However, use of urate-lowering drugs may reduce plasma urate concentrations enough to allow resorption of tophi and prevent painful tophaceous gout. Some patients may have mechanical problems from tophi, despite adequate control of acute arthritis; in such situations, joint replacement or surgical excision of tophi may be necessary.
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Sham HL, Kempf DJ, Molla A, Marsh KC, Kumar GN, Chen CM, Kati W, Stewart K, Lal R, Hsu A, Betebenner D, Korneyeva M, Vasavanonda S, McDonald E, Saldivar A, Wideburg N, Chen X, Niu P, Park C, Jayanti V, Grabowski B, Granneman GR, Sun E, Japour AJ, Leonard JM, Plattner JJ, Norbeck DW. ABT-378, a highly potent inhibitor of the human immunodeficiency virus protease. Antimicrob Agents Chemother 1998; 42:3218-24. [PMID: 9835517 PMCID: PMC106025 DOI: 10.1128/aac.42.12.3218] [Citation(s) in RCA: 331] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/1998] [Accepted: 09/11/1998] [Indexed: 11/20/2022] Open
Abstract
The valine at position 82 (Val 82) in the active site of the human immunodeficiency virus (HIV) protease mutates in response to therapy with the protease inhibitor ritonavir. By using the X-ray crystal structure of the complex of HIV protease and ritonavir, the potent protease inhibitor ABT-378, which has a diminished interaction with Val 82, was designed. ABT-378 potently inhibited wild-type and mutant HIV protease (Ki = 1.3 to 3.6 pM), blocked the replication of laboratory and clinical strains of HIV type 1 (50% effective concentration [EC50], 0.006 to 0.017 microM), and maintained high potency against mutant HIV selected by ritonavir in vivo (EC50, =0. 06 microM). The metabolism of ABT-378 was strongly inhibited by ritonavir in vitro. Consequently, following concomitant oral administration of ABT-378 and ritonavir, the concentrations of ABT-378 in rat, dog, and monkey plasma exceeded the in vitro antiviral EC50 in the presence of human serum by >50-fold after 8 h. In healthy human volunteers, coadministration of a single 400-mg dose of ABT-378 with 50 mg of ritonavir enhanced the area under the concentration curve of ABT-378 in plasma by 77-fold over that observed after dosing with ABT-378 alone, and mean concentrations of ABT-378 exceeded the EC50 for >24 h. These results demonstrate the potential utility of ABT-378 as a therapeutic intervention against AIDS.
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McDonald E. The role of Project 2000 educated nurses in health promotion within the hospital setting. NURSE EDUCATION TODAY 1998; 18:213-220. [PMID: 9661448 DOI: 10.1016/s0260-6917(98)80081-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study is concerned with the role of Project 2000-educated nurses in health promotion within the hospital setting. Historically nurses have been viewed as having a role to play in promoting the health of the people for whom they care. More recently, with the advent of the Health For All Movement initiated by the World Health Organization in 1978, the attention has again been focused on what nurses can do towards attainment of this goal, although most of the research has been carried out in relation to community nurses and primary care. Changes in nurse education, specifically that of Project 2000 nurse education, have been hailed as the opportunity to equip nurses with knowledge and skills appropriate to the task, which have been seen as lacking from many nurse educational programmes. Early work on this issue has produced conflicting findings as to the success of these educational changes. This study used an exploratory, qualitative approach to investigate what aspects of health promotion in the hospital setting are being carried out by nurses who have undergone Project 2000 nurse education within a college of nursing and midwifery in Scotland, and whether these nurses feel that they have been adequately prepared for this role during their educational programme. Findings suggest that the nurses interviewed were working with very wide perceptions of health promotion which included the more radical aspects of health promotion such as negotiation, collaboration and empowerment. Health promotion was also seen to include psychosocial factors that influence the health of individuals. The nurses interviewed in general felt that their education had prepared them for a role in health promotion. The value of clinical placements in facilitating the developing the skills for health promotion was established.
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Kempf DJ, Sham HL, Marsh KC, Flentge CA, Betebenner D, Green BE, McDonald E, Vasavanonda S, Saldivar A, Wideburg NE, Kati WM, Ruiz L, Zhao C, Fino L, Patterson J, Molla A, Plattner JJ, Norbeck DW. Discovery of ritonavir, a potent inhibitor of HIV protease with high oral bioavailability and clinical efficacy. J Med Chem 1998; 41:602-17. [PMID: 9484509 DOI: 10.1021/jm970636+] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The structure-activity studies leading to the potent and clinically efficacious HIV protease inhibitor ritonavir are described. Beginning with the moderately potent and orally bioavailable inhibitor A-80987, systematic investigation of peripheral (P3 and P2') heterocyclic groups designed to decrease the rate of hepatic metabolism provided analogues with improved pharmacokinetic properties after oral dosing in rats. Replacement of pyridyl groups with thiazoles provided increased chemical stability toward oxidation while maintaining sufficient aqueous solubility for oral absorption. Optimization of hydrophobic interactions with the HIV protease active site produced ritonavir, with excellent in vitro potency (EC50 = 0.02 microM) and high and sustained plasma concentrations after oral administration in four species. Details of the discovery and preclinical development of ritonavir are described.
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Kempf DJ, Sham HL, Marsh KC, Flentge CA, Betebenner D, Green BE, McDonald E, Vasavanonda S, Saldivar A, Wideburg NE, Kati WM, Ruiz L, Zhao C, Fino L, Patterson J, Molla A, Plattner JJ, Norbeck DW. Discovery of ritonavir, a potent inhibitor of HIV protease with high oral bioavailability and clinical efficacy. J Med Chem 1998. [PMID: 9484509 DOI: 10.1021/jm970636] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The structure-activity studies leading to the potent and clinically efficacious HIV protease inhibitor ritonavir are described. Beginning with the moderately potent and orally bioavailable inhibitor A-80987, systematic investigation of peripheral (P3 and P2') heterocyclic groups designed to decrease the rate of hepatic metabolism provided analogues with improved pharmacokinetic properties after oral dosing in rats. Replacement of pyridyl groups with thiazoles provided increased chemical stability toward oxidation while maintaining sufficient aqueous solubility for oral absorption. Optimization of hydrophobic interactions with the HIV protease active site produced ritonavir, with excellent in vitro potency (EC50 = 0.02 microM) and high and sustained plasma concentrations after oral administration in four species. Details of the discovery and preclinical development of ritonavir are described.
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Marsh KC, Eiden E, McDonald E. Determination of ritonavir, a new HIV protease inhibitor, in biological samples using reversed-phase high-performance liquid chromatography. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 1997; 704:307-13. [PMID: 9518164 DOI: 10.1016/s0378-4347(97)00454-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A simple, accurate and precise high-performance liquid chromatographic method has been developed for measurement of ritonavir concentrations in human plasma. Ritonavir was partitioned from the plasma using liquid-liquid extraction with a mixture of ethyl acetate and hexane at neutral pH, with an average recovery >80%. Following two sequential washings of the reconstituted sample with hexane, chromatographic separation was accomplished on a C18 analytical column with a mobile phase containing acetonitrile, methanol and 0.01 M tetramethylammonium perchlorate in 0.1% aqueous trifluoroacetic acid (40:5:55, v/v) with low wavelength UV detection at 205 nm. Standard curves were linear (r2>0.9998) over the concentration range 0.01-15 microg/ml with both inter- and intra-day coefficients of variation typically less than 5%. The stability of ritonavir in plasma was excellent, with no evidence of degradation after 5 days at room temperature or after 6 months in a freezer. Decontamination procedures for HIV-positive plasma samples showed 5.6 and 10.2% degradation following heating to 60 degrees C for 30 or 60 min, respectively.
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Weller D, Johnson D, McDonald E, Mooney K, O'Neill MS, Winterhalter A, Yackanich R. Functional teams lead to Joint Commission success. J Nurs Care Qual 1997; 12:14-26. [PMID: 9397636 DOI: 10.1097/00001786-199712000-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
As the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) has shifted the focus of its survey process to the organization as a whole, new techniques are needed to prepare for surveys. Staten Island University Hospital used teams based on the eleven important functions to achieve a successful survey.
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Kempf DJ, Marsh KC, Kumar G, Rodrigues AD, Denissen JF, McDonald E, Kukulka MJ, Hsu A, Granneman GR, Baroldi PA, Sun E, Pizzuti D, Plattner JJ, Norbeck DW, Leonard JM. Pharmacokinetic enhancement of inhibitors of the human immunodeficiency virus protease by coadministration with ritonavir. Antimicrob Agents Chemother 1997; 41:654-60. [PMID: 9056009 PMCID: PMC163767 DOI: 10.1128/aac.41.3.654] [Citation(s) in RCA: 323] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Coadministration with the human immunodeficiency virus (HIV) protease inhibitor ritonavir was investigated as a method for enhancing the levels of other peptidomimetic HIV protease inhibitors in plasma. In rat and human liver microsomes, ritonavir potently inhibited the cytochrome P450 (CYP)-mediated metabolism of saquinavir, indinavir, nelfinavir, and VX-478. The structural features of ritonavir responsible for CYP binding and inhibition were examined. Coadministration of other protease inhibitors with ritonavir in rats and dogs produced elevated and sustained plasma drug levels 8 to 12 h after a single dose. Drug exposure in rats was elevated by 8- to 46-fold. A > 50-fold enhancement of the concentrations of saquinavir in plasma was observed in humans following a single codose of ritonavir (600 mg) and saquinavir (200 mg). These results indicate that ritonavir can favorably alter the pharmacokinetic profiles of other protease inhibitors. Combination regimens of ritonavir and other protease inhibitors may thus play a role in the treatment of HIV infection. Because of potentially substantial drug level increases, however, such combinations require further investigation to establish safe regimens for clinical use.
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Boothroyd A, McDonald E, Moores BM, Sluming V, Carty H. Radiation exposure to children during cardiac catheterization. Br J Radiol 1997; 70:180-5. [PMID: 9135445 DOI: 10.1259/bjr.70.830.9135445] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The purpose of this study was to assess the suitability of different radiation dosimetry methods and record radiation exposures during paediatric catheterization. Three methods of dosimetry were employed: thermoluminescent dosimetry (TLD), dose-area product and calculation of entrance surface dose from calibrated exposure factors. Examinations included bi-plane fluoroscopy, and cineangiography for diagnosis and treatment of congenital heart disease. The most suitable method of radiation dosimetry for cardiac catheterization is the use of calculated entrance dose or a dose-area product meter. Children were exposed to high levels of radiation during cardiac catheterization but there was a wide variation in radiation dosage. Careful consideration should be given to the suitability of radiation dosimetry for cardiac catheterization.
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