Plants used against cancer - an extension of the work of Jonathan Hartwell.

A survey of plants used ethnomedically against cancer was undertaken, using the NAPRALERT database currently maintained by the Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy, University of Illinois-Chicago. We report over 350 species which are reported to be used against cancer and not cited in the work of Jonathan Hartwell, "Plants used against cancer: a survey", including previously unrepresented genera and families.

Insertional inactivation of the gene for the meningococcal lactoferrin binding protein.

The lactoferrin binding protein (LBP) of Neisseria meningitidis (the putative meningococcal receptor for human lactoferrin, LF), has been previously characterized as an outer-membrane protein of approximately 105 kDa. Using N-terminal amino acid sequence to generate an oligonucleotide probe, a clone from a lambda gt11 phage library was isolated. This clone was subjected to shuttle mutagenesis, in which an erythromycin mini-transposon was used to interrupt the LBP coding sequence. This insertion mutation was introduced into the meningococcus. A N. meningitidis strain that carried this transposon insertion no longer produced the 105 kDa protein. The absence of this protein was correlated with the inability to bind LF or to use LF as an iron source. The LBP mutant was able to grow with other Fe sources and demonstrated no other visible membrane protein alterations. These data confirm the suggestion that LBP is the meningococcal receptor.

Improved safety and efficacy in adaptive control of arterial blood pressure through the use of a supervisor.

This paper presents a dual approach to adaptive control of arterial blood pressure using sodium nitroprusside. In the clinical environment, a controller must be aggressive to achieve specific step response characteristics (less than 10 min settling time, less than 10 mm Hg overshoot), yet conservative enough to prevent overreactions to large disturbances, which are common in both the operating room and the intensive care unit. These mutually exclusive requirements make it difficult to design a closed-loop controller for this environment. To prevent possible overreactions, while maintaining proper step response, an aggressive adaptive controller has been designed to achieve the desired step response, and a SUPERVISOR has been designed around the adaptive controller to limit potential overreactions in the presence of disturbances. Simulations and dog experiments demonstrate the potential for increased safety and efficacy using this dual approach to the control of a complex physiological system.

Supervisory adaptive control of arterial pressure during cardiac surgery.

A supervisory adaptive controller has been designed for the closed-loop control of mean arterial pressure during cardiac surgery, using sodium nitroprusside. This controller consists of a pole-placement and proportional-plus-integral feedback regulator, multiple-model adaptation, and a supervisor. The pole-placement and proportional-plus-integral regulator was designed to meet aggressive step response characteristics. Multiple-model adaptation was chosen to ensure rapid and stable adjustments for changes in key patients parameters. The supervisor was designed to provide safety and efficacy of control during disturbances that are common during cardiac surgery. We studied the ability of this supervisory adaptive controller to regulate arterial pressure during cardiac surgery on nineteen patients. The controller, through the action of the supervisor, detected and responded appropriately to the great majority of disturbances. This study demonstrated that supervisory adaptive control has the potential to provide clinically acceptable regulation of arterial pressure.

Recognition accuracy with a voice-recognition system designed for anesthesia record keeping.

We tested on three occasions, with anesthetists as subjects, the accuracy of two voice-recognition systems designed for anesthetic record keeping. Initially, a prototype system was tested (10 subjects); several years later the resulting commercial system was tested in a quiet environment (11 subjects) and in noisy operating rooms (10 subjects). For each test an anesthetist first trained the system to recognize his or her voice by reading aloud a list of common anesthetic terms. To determine recognition accuracy, the percentage of words recognized correctly by the computer, each subject repeated the vocabulary words ten times. Although accuracy was similar during the three tests, it was slightly higher with the laboratory test (mean percent of words recognized correctly, 96.5%; range of accuracy for individual anesthetists, 91.6 to 98.8%) than with the prototype test (95.9%; range, 89.1 to 99.6%). Accuracy was lowest with the operating room test (95.3%; range, 87.8 to 98.4%). Twenty-four words caused particular difficulty during the laboratory test and were eliminated from the vocabulary of the subsequent operating room test. Omitting these 24 words from the laboratory vocabulary list allowed a more nearly direct comparison with the results from the operating room list; recognition accuracy improved in the former to 97.5% (range, 92.1 to 98.9%). Two anesthetists--one each from the laboratory and operating room tests--performed poorly, and eliminating their scores changed the respective overall scores to 98.2% (range, 96.7 to 98.9%) and 96.5% (range, 94.3 to 98.4%). Thus, the corrected difference between the laboratory accuracy and the operating room accuracy was 1.7%.(ABSTRACT TRUNCATED AT 250 WORDS)

Semipractical alarms: a parable.

Current alarms protect the manufactures of medical equipment from liability but do little to improve the quality of patient care. Existing alarms are so intrusive that the response of the anesthesiologist and others in the operating room is to want the offensive noise to go away, rather than to address potentially life-threatening situations. Alarms need to be refined so that only those whose attention is required (e.g., the anesthesiologist) are disturbed. It should always be immediately clear which particular variable is outside accepted limits, and alarms for different variables should operate independently so that if one alarm fails, others will still work.

NAPRALERT: computer handling of natural product research data.

Research in natural products, not unlike many other fields of investigation, requires access to large amounts of prior experimental data relevant to specific projects. The most efficient method of identifying and analyzing these data currently employs computer handling of the information. The NAPRALERT database has been designed to meet this need relevant to the development of natural products. It has also been designed, through analysis of existing literature and its contained data, to provide a means to predictively identify taxonomic sources most promising from specific biological activities.

Automatic control in anesthesia: a comparison in performance between the anesthetist and the machine.

This report is divided into two parts. First, we developed two new servo control systems by modifying an existing one. The original system was designed to control inspired halothane concentration using mean arterial pressure; the two new systems were designed to control inspired halothane concentration using end-tidal concentration or to control mean arterial pressure using the automated infusion of nitroprusside. Second, we compared the performance of experienced physician and nurse anesthetists (nine, six, and six experiments, respectively). The experiments incorporated a standardized testing sequence of two changes in desired blood pressure (set point) and two pharmacologically induced disturbances in blood pressure (perturbations). The scoring was designed to examine how fast blood pressure changed (90% response time), how far past the set point it went (overshoot), how long it took to eliminate most of the fluctuations in blood pressure (settling time), and the degree of fluctuation of blood pressure after settling (stability). Given three systems to be tested, there were (3 X 14) 42 possible mean scores for the machine and 42 for the anesthetists. The machine scored better than the anesthetists in 38 out of 42 of the mean scores; the differences were statistically significant in 19 out of 42 scores. The wide scatter in performances of the anesthetists prevented the achievement of significance in nine cases with large differences between means. Thus when the scores from the three systems were combined to achieve a larger n value, the machine outperformed the anesthetist in 12 out of 14 scores.(ABSTRACT TRUNCATED AT 250 WORDS)

EEGs during high-dose fentanyl-, sufentanil-, or morphine-oxygen anesthesia.

In 49 patients undergoing open-heart surgery we compared the electroencephalographic (EEG) effects of high-dose morphine, fentanyl, or sufentanil with O2, using two computerized analysis and display techniques: a period analysis (the Klein method) and an aperiodic analysis (the Neurometrics monitor). During fentanyl or sufentanil anesthesia, both techniques revealed a general decrease in frequency, shown by the aperiodic analysis primarily as a marked increase in the very low frequency range: an increase in the 1-Hz bin (TP1, in muv2) from 2.80 X 10(4) +/- 3.20 X 10(4) (SD) to 45.1 X 10(4) +/- 27.2 X 10(4) for fentanyl and from 3.11 X 10(4) +/- 2.83 X 10(4) to 52.8 X 10(4) for sufentanil. The cumulative percent power at 3 Hz (CP3) increased from 27.2 +/- 6.8 to 83.0 +/- 11.0 for fentanyl and from 22.7 +/- 5.2 to 85.1 +/- 10.4 for sufentanil, while the frequency at 90% cumulative percent power (F90, in Hz) decreased from 17.8 +/- 2.9 to 7.9 +/- 2.8 for fentanyl and 16.4 +/- 5.2 to 5.6 +/- 4.3 for sufentanil. The changes with morphine were less obvious, with some attenuation of high-frequency power shown by the Klein method, and an increase from 24.1 +/- 8.6 to 59.3 +/- 20.7 with CP3, but no change in TP1. Low-frequency power with the period analysis and TP1 with the aperiodic analysis decreased between laryngoscopy and the incisions with fentanyl and sufentanil.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative microbiological monitoring of hemodialysis fluids: evaluation of methods and demonstration of lack of test relevance in single-pass hemodialysis machines with automatic dialysate proportioning with reverse osmosis-treated tap water.

Two methods for estimating the quantity of microorganisms present in hemodialysis fluid, a blood agar surface-spread plate method and a total-count water tester device impregnated with modified standard plate count agar (Millipore Corp., Bedford, Mass.), were evaluated. Both methods exhibited comparable precision; however, colony counts obtained with the total-count water tester were consistently and unacceptably low. The need for routine quantitative microbiological monitoring of hemodialysis fluids such as that recommended by the American Public Health Association was not supported by the results of this study. Such testing was not of value in predicting untoward reactions for patients undergoing hemodialysis, nor did quantitative testing of hemodialysis fluids identify the buildup of potentially hazardous levels of contamination within hemodialysis systems. Finally, the kinds of organisms found in hemodialysis systems, i.e., gram-negative water-borne bacilli, were elucidated.

Antiinflammatory activity of Tylopilus felleus (Bull. ex Fr.) P. Karst.

Tylopilus felleus lyophylised preparation (Tf) tested in the carrageenin induced oedema test in rats, exhibit a significant inhibition of inflammation at all doses above 50 mg/kg sc while oral administration produced no significant results.

Dose-ranging trial of N-acetylprocainamide in patients with premature ventricular contractions.

Ten patients with chronic premature ventricular contractions (PVCs) received short-term oral therapy with N-acetylprocainamide (NAPA) to determine its antiarrhythmic efficacy and side effects under the conditions of a placebo-controlled, dose-ranging trial. NAPA was effective in suppressing PVCs in 8 patients but caused a paradoxical increase in PVC frequency in one. Results were equivocal in the remaining patient because PVCs did not recur when NAPA therapy was withdrawn. Mean NAPA plasma levels as high as 41.1 microng/ml did not have untoward hypotensive or myocardial depressant effects, as judged by electrocardiographic and systolic time intervals. There was, in fact, a consistent reduction in PEP/LVET ratio, indicating that NAPA increases the force of myocardial contraction. The mean NAPA elimination half-life of 10.9 hr was longer than the 6.2 hr half-life reported for normal subjects, but its prolongation was predictably correlated with reductions in creatinine clearance. Gastrointestinal side effects experienced by 3 patients and insomnia noted by 2 patients are similar to known adverse reactions to procainamide.

Continuous electrocardiogram monitoring in a surgical intensive care unit.

We tested a computer system for routine arrhythmia monitoring in 181 postoperative patients in order to evaluate its practical value. There was no significant difference in the incidence of arrhythmias between patients clinically classified in poor condition and those classified in good condition. Conventional vital signs appeared to have more value than a PVC count or an index of arrhythmias. We found no evidence that continuous electrocardiogram monitoring might provide an early warning signal in these patients monitored.