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Biomedical subjects

A Murray

Publications and source records attributed to A Murray.

At least 271 records · Page 15Linked to original sources
PubMed1993

Air-fluidized beds and their ability to distribute interface pressures generated between the subject and the bed surface.

Pressures were measured under five anatomical sites prone to pressures sores for ten subjects, supine and sitting on two different air-fluidized beds. The beds were the Clinitron (trademark, SSI) and the Fluidair Plus (trademark, KCI Mediscus). Mean supine pressures were less than 4 kPa under four sites. The average supine buttock pressure was 2.65 kPa. This increased to 3.71 kPa upon sitting up, though pressures did not rise above the accepted capillary closing pressure, on either bed. Low interface pressures at these sites were due to good moulding between subject and bed. Heel pressures averaging 7.08 kPa, were a factor of 2.67 times greater than buttock pressure, and were higher than expected considering the depth the heels sunk to in both beds. This exceeded the accepted capillary closing pressure and was attributed to covering sheets preventing true floatation at the heels.

Adult↗
PubMed1993

Multiple B-cell epitopes in a recombinant GRA2 secreted antigen of Toxoplasma gondii.

Two cDNA clones encoding the GRA2 (G.P.28.5) secreted antigen of Toxoplasma gondii were expressed in Escherichia coli as glutathione-S-transferase fusion polypeptides. A high level of expression was obtained for the first clone expressing the 59C-terminal amino acids of GRA2. The other one was an open-reading-frame of 212 amino acids containing the entire GRA2 cDNA. By ELISA, IgG antibodies directed against the 59aa recombinant polypeptide were detected in 33/44 (75%) sera from patients chronically infected with T. gondii and in 19/23 (82.6%) sera derived from patients with acute, primary toxoplasmosis. 10 of the 11 "chronic" sera which were negative by the 59aa ELISA were tested in a immunoblot against the 212aa open-reading-frame of GRA2: 8/10 were positive. A peptide representing the 15 C-terminal amino acids of GRA2 has been shown to contain the epitope recognized by a mouse monoclonal antibody (TG17-179). The reactivity of human sera with the 59aa recombinant polypeptide was inhibited to varying degrees when the sera were co-incubated with this peptide. Twelve chronic sera showed a range of inhibition from 8 to 100% and twelve acute sera an inhibition range of 15 to 90%. This suggests that the 15aa C-terminal peptide contains an epitope recognized in both the acute and chronic phases of infection and that other major epitope(s) exist in the 59aa C-terminal region of GRA2. As a conclusion, the recombinant GRA2 protein appears to contain at least three B-cell epitopes.

Acute Disease↗
PubMed1993

How should the repeatability of clinical measurements be analysed? An assessment of analysis techniques with data from cardiovascular autonomic function tests.

A reliable clinical test should give similar results when repeated on the same patient. Repeatability data, however, can be presented in several ways, giving apparently different results. We compared two approaches--the coefficient of variation, and the SD ratio (SD of repeat measurements/SD of subject means). Repeat measurements of two published studies of cardiovascular autonomic function response were analysed. The test measurements were divided into two groups: group A tests, for which no response results in a zero output (includes measurements of differences or changes); and group B tests, for which no response results in a unity or other non-zero output (includes measurements of ratios). Data were obtained from 10 normal and 25 diabetic subjects. There were significant differences between the coefficients of variation of the two groups of tests for the normal subjects (p < 0.01) and for the diabetic subjects (p < 0.01). Low coefficients of variation were more likely to belong to group B (ratio measurements) than to be an estimate of good repeatability. The calculation of the coefficient of variation was adapted to ensure that the test calculation tended to zero with low autonomic function. There was a strong relationship, especially with the diabetic subjects, between repeatability calculated from the adapted coefficient of variation and from the SD ratio (normal subjects, r = 0.63; diabetic subjects, r = 0.91). The calculation of coefficient of variation is often misused, and low coefficients of variation presented in the literature may not represent good repeatability of a clinical test.

Adolescent↗
PubMed1993

Plasma potassium, serum magnesium and ventricular fibrillation: a prospective study.

Low plasma potassium and magnesium concentrations have been advanced as risk factors for ventricular fibrillation (VF). For potassium, this assertion is based almost exclusively on retrospective data; for magnesium the evidence shows an association with ventricular arrhythmias but no direct association with VF. We studied the relationship between these electrolytes and VF prospectively. Plasma potassium and serum magnesium concentrations were measured on admission to our coronary care unit. Drug therapy, time from onset of symptoms, ECG, enzyme changes and clinical status were all recorded. VF was confirmed by analysis of 24 h monitoring tapes. Mean plasma potassium in the 21 patients with VF who had measurements prior to their arrhythmia was 3.49 +/- 0.54 mmol/l, lower than that of the 1165 patients without VF (mean K 3.88 +/- 0.57 mmol/l, p < 0.05). Plasma potassium concentrations in the 17 patients with myocardial infarction and VF were lower (mean 3.58 +/- 0.41 mmol/l) than in those without VF (n = 417, mean 3.89 +/- 0.61 mmol/l) (p < 0.05). Mean serum magnesium in the 12 patients with VF, measured prior to their arrhythmia (all with myocardial infarction) was 0.80 +/- 0.07 mmol/l, which was not different from the mean for patients without VF (n = 781, 0.82 +/- 0.09 mmol/l) or from the mean of 0.81 +/- 0.08 mmol/l for those with infarction but not VF (n = 331). Low plasma potassium concentrations are associated with increased risk of ventricular fibrillation, but low serum magnesium concentrations are not.

Female↗
PubMed1993

Can we afford to take short cuts in the management of stress urinary incontinence?

Is urodynamics necessary in the management of female stress urinary incontinence? This has remained a point of contention among urologists and gynaecologists alike. In this prospective study we evaluated 28 patients urodynamically to assess our diagnostic accuracy and to audit our intended management. These patients had complained solely or predominantly of stress incontinence. None of them had previous abdominal or vaginal surgery for stress urinary incontinence or a history suggestive of voiding disorder. All 28 of them were listed for either a Burch colposuspension or Stamey endoscopic bladder neck suspension operation based on demonstrating the sign stress incontinence clinically or radiologically on screening cystography. In all these cases the diagnosis of genuine stress incontinence was presumed and urodynamics would not have been performed preoperatively, if not for this study. As a result, there was a 21% overall change in the intended management. Routine but simplified urodynamics (to include pad test, provocative cystometry, uroflowmetry and residual urine measurement) would appear to be a pre-requisite of genuine stress incontinence surgery, even in patients complaining solely of stress incontinence.

Adult↗
PubMed1993

Peritonitis due to colonic ileus after cesarean section. A report of two cases.

Delayed "primary" peritonitis after cesarean section is very uncommon. In two patients, generalized peritonitis occurred two to three weeks after uneventful operations. Exploratory laparotomies in both cases revealed generalized peritonitis, with massive colonic dilation that was suggestive of pseudo-obstruction as the only positive finding. There was no evidence of perforation or mechanical obstruction, or of ascending pelvic infection. The cause of peritonitis could be "toxic megacolon" due to pseudo-obstruction.

Adult↗
PubMed1992

An orthodontic tour of Australia.

In September 1989, I entered the competition sponsored by Orthologic Ltd which is held annually at the British Orthodontic Conference. This involves presentation of three cases treated by an edgewise system, either conventional or pre-adjusted, and is judged on the quality of the result and the standard of records that form the presentation. The prize, which I was lucky enough to win, is 2000 pounds towards travel to visit centres of excellence.

Australia↗
PubMed1992

Lasers in surgery.

In January 1991 the winter meeting of the Surgical Research Society was held at St. Bartholomew's Hospital and the Institute of Education, London. During the meeting a symposium was held entitled 'Shedding light on lasers'. Speakers addressed the general principles of lasers, laser-tissue interactions and the applications of lasers in gastro-enterology and in vascular disease. This was followed by an open discussion of the current indications, complications and outcome, together with future possible applications for lasers in medicine.

Arterial Occlusive Diseases↗
PubMed1992

Laser-assisted angioplasty for arterial occlusion of the lower limb: initial results and follow-up.

A flashlamp-pumped pulsed dye laser operating at either 480 or 504 nm, coupled to an integral ball-tipped optical fibre, was used to recanalize occluded lower limb arteries. All channels created by the laser were augmented with balloon dilatation. We have treated 78 limbs in 71 patients; 46 limbs (59 per cent) had rest pain and 22 (48 per cent) of these had tissue loss. The median occlusion length was 18 (range 0.5-58) cm. Technical success was achieved in 58 limbs (74 per cent) with clinical success in 46 (59 per cent). Success rates fell with increasing length of occlusion. Two patients died in the perioperative period. A subgroup of 22 patients with marked discrete arterial calcification had a lower technical success rate than the subgroup without calcification (50 per cent versus 84 per cent, P less than 0.01). Both subgroups displayed a similar pattern of reclosure during follow-up. The cumulative patency rate after technical success was 67 per cent at 6 months and 45 per cent at 12 months. Forty-six (59 per cent) limbs avoided bypass surgery or amputation. Laser-assisted angioplasty may offer an alternative to femoropopliteal bypass, although the former procedure is not as durable.

Adult↗
PubMed1992

Is fetal heart rate monitoring sufficiently sensitive to detect changes during labour?

Although fetal monitoring is a common clinical procedure, there is little quantitative evidence that it can detect changes occurring during labour. We present quantitative data comparing the first and second stage of labour, from 21 labours resulting in a normal fetal outcome. A range of fetal heart rate variables was calculated from the output of a fetal heart rate monitor. Significant changes were detected in baseline fetal heart rate (P less than 0.005), heart rate variability (P less than 0.05), number of dips (P less than 0.01) and their depth (P less than 0.01). The results encourage confidence in the sensitivity of fetal monitoring for the detection of changes in a number of fetal heart rate variables during the course of labour.

Electrocardiography↗
PubMed1992

Amino acid sequence requirements for the epitope recognized by a monoclonal antibody reacting with the secreted antigen GP28.5 of Toxoplasma gondii.

We have characterized in detail, the epitope of the secreted antigen GP28.5 recognized by the mouse monoclonal antibody TG 17-179 using synthetic peptides and a truncated recombinant fusion protein. The screening of a T. gondii expression library with TG17-179 mAb led to the isolation of cDNAs clones, all encoding for the C-terminal region of GP28.5 and with one encoding for only the five last C-terminal residues. Competitive ELISA with longer peptides revealed that the immunoreactivity was retained for peptides of eight residues or longer, and lost when the peptide was reduced to the six last C-terminal residues or less. Experiments with the octapeptide lacking the carboxy-terminal glutamine residue showed it to be 64-fold less active. Moreover, neither addition of residues in the carboxy-end nor substitution of COOH function changed the immunoreactivity of the epitope. Competition experiments between TG17-179 mAb and sera from infected individuals demonstrates that the epitope defined by a mouse monoclonal probe is also a major epitope for human polyclonal antibodies. These results describe the sequence requirements within a probably linear epitope and give rise to some general question concerning experimental test for epitope mapping.

Amino Acid Sequence↗
PubMed1992

Characterisation of avian adenoviruses associated with inclusion body hepatitis.

Eleven avian adenoviruses were isolated in monolayer cultures of specific pathogen free chicken kidney cells which were inoculated with suspensions of liver, intestine or bursa obtained from 15 broiler flocks experiencing outbreaks of inclusion body hepatitis (10 isolates) and from five unaffected flocks (one isolate). Of the 11 isolates obtained, nine were identified by virus neutralisation tests as serotype 8, one as serotype 1 and one as serotype 12. Adeno-associated viruses were only observed in combination with adenoviral particles of the serotype 12 isolate which was derived from a relatively mild outbreak of inclusion body hepatitis. Only the serotype 1 isolate, obtained from the unaffected broiler flock, consistently caused the death of embryos with marked pathological changes. All of the isolates produced basophilic intranuclear inclusion bodies surrounded by clear halos in chicken kidney cell cultures. DNA preparations, obtained from six strains of serotype 8 avian adenovirus (two New Zealand isolates, three Australian isolates and the reference strain HVI) after digestion with the restriction enzymes EcoRI and BamHI, gave electrophoretic patterns showing the New Zealand isolates to be similar to one another and to strain HVI, but quite distinct from the Australian isolates.

Journal Article↗
PubMed1992

Assessment of oxygen transfer in membrane oxygenators during clinical cardiopulmonary bypass.

Although functional replacement of the heart and lungs by a pump and oxygenator is a widespread surgical procedure, no widely accepted technique for describing gas exchange in oxygenators exists. In this study, 8 types of commercially available membrane oxygenator (2 flat sheet membrane, 4 gas in hollow fibre membrane and 2 blood in hollow fibre membrane) have been studied during clinical cardiopulmonary bypass. O2 transfer increased with blood flow rate but the O2 transfer at a given blood flow was lower than that obtained by the manufacturers in laboratory studies. Overall O2 transfer coefficients were calculated from the ratio of O2 transfer rate to an O2 difference expressed either as an O2 partial pressure or an O2 concentration. Specific O2 transfer coefficients (overall coefficient divided by membrane area) were similar for oxygenators with a flat sheet or gas in hollow fibre membrane configuration. The two types of oxygenator with blood in hollow fibre membranes had significantly lower (P less than 0.01) specific O2 transfer coefficients. This study shows that oxygenator gas transfer characteristics can be studied in the clinical environment and that O2 transfer coefficients can be related to oxygenator design features.

Aged↗
PubMed1992

Expression of Escherichia coli beta-galactosidase in Mycobacterium bovis BCG using an expression system isolated from Mycobacterium paratuberculosis which induced humoral and cellular immune responses.

A promoter sequence, PAN, was isolated from Mycobacterium paratuberculosis and characterized. This promoter lies adjacent to, and outside, the 3' end of an IS900 insertion element. IS900 contains an open reading frame, ORF2, on the complementary strand which codes for the putative transposase of this insertion sequence. A DNA fragment containing PAN and part of ORF2 was fused to the lacZ gene and inserted into the replicative shuttle vector pRR3. Mycobacterium smegmatis and Mycobacterium bovis BCG (BCG) transformed with this plasmid exhibited beta-galactosidase activity. However, lacZ was only expressed in Escherichia coli under the control of PAN, when ORF2 was deleted. Immunization of mice with the recombinant M. bovis BCG expressing lacZ resulted in the induction of a high humoral and cellular response directed against beta-galactosidase. The PAN-ORF2 expression system may prove to be particularly useful for cloning and expression of heterologous genes in the BCG vaccine strain.

Amino Acid Sequence↗
PubMed1992

Autonomic function testing in diabetic subjects using sequential measurements.

The repeatability of commonly used electrocardiographic (ECG) related autonomic function tests was investigated in 25 diabetic subjects, mean age 44 (range 18-67) years and mean duration of diabetes 10 (< 1-35) years. Tests were based on deep breathing, the Valsalva manoeuvre, relaxed normal breathing, and standing up from a lying position. All tests were repeated twice at each session, with two sessions separated by a mean of 5 (range 3-8) months. ECG and respiratory data were recorded for subsequent analysis. Maximum (max) and minimum (min) RR intervals and instantaneous heart rate (HR) were determined. The mean and repeatability data (within-subject standard deviation) for 21 different test results were calculated, and included deep breathing sitting (max-min)RR 226 +/- 39 ms and (max-min)HR 19.3 +/- 3.2 beats min-1, Valsalva manoeuvre 1.74 +/- 0.18, and lying-to-standing RR ratio 1.19 +/- 0.07. The within-subject repeatability to between-subject variability ratios consistently demonstrated that it is better to perform the deep breathing test sitting (with the smaller mean ratio of 0.37) rather than supine (0.46), with the use of three respiratory cycles rather than a single cycle (0.33 compared with 0.50 for (max-min)RR). A significant (p = 0.037) relationship was found between variability in heart rate changes and variability in air volume breathed during the deep breathing test.

Adolescent↗
PubMed1992

Repeatability of measurements and sources of variability in tests of cardiovascular autonomic function.

OBJECTIVE: To determine the repeatability and sources of variability of clinical tests of cardiovascular autonomic function. DESIGN: The commonly used electrocardiographic related tests of autonomic function were studied. Two repeat measurements of all tests were made on all subjects on four separate days over a four week period. SUBJECTS: Ten normal subjects with no known autonomic dysfunction were investigated. MAIN OUTCOME MEASURES: These were deep breathing (subject seated and supine), Valsalva manoeuvre, standing up from lying position, and normal relaxed breathing (subject supine). During the tests the electrocardiogram and respiratory pattern were recorded by computer. Beat to beat RR intervals were measured automatically from the electrocardiogram, and from these the results of the tests were calculated. RESULTS: Variance analysis showed significant between subject variability for all tests (p < 0.005), but some tests showed a much smaller relative within subject variability than others. Average repeatability data (within subject SD) for each test were calculated, and included deep breathing sitting (max-min) RR (46 ms), Valsalva ratio (0.17), and lying to standing RR ratio (0.11). These compare with between subject SDs of 65 ms, 0.38, and 0.13 respectively, at mean values of 305 ms, 1.92, and 1.15 respectively. The data highlighted one subject with the poorest repeatability, whose electrocardiogram turned out on closer inspection to be under atrial rather than sinus control at times. Poor repeatability in the other subjects was related to variability in the respiratory pattern, and in the deep breathing test, repeat variability was significantly correlated (r = 0.79) with variability in the respiratory amplitude (p < 0.05). CONCLUSIONS: Repeatability data should be available to each laboratory carrying out autonomic function tests. The data provided in this study could be used as a baseline. Poor repeatability highlights the need to re-examine the test procedures, or the test data from specific subjects. Variability of respiratory pattern is associated with poor repeatability, and so careful instructions on respiration should be given to each subject before the tests.

Adult↗