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Biomedical subjects

C Smith

Publications and source records attributed to C Smith.

At least 577 records · Page 32Linked to original sources
PubMed1993

Depression and the experience of chronic back pain: a study of related variables and age differences.

OBJECTIVE: To document the prevalence of depression and examine the relationship between depression and selected pain-related variables associated with chronic back pain among elderly and nonelderly samples. DESIGN: Survey with mailed questionnaire. SETTING: Patients seeking treatment at a spine diagnostic and treatment center. PATIENTS: Consecutive sample of elderly subjects (n = 69). Nonelderly subjects (n = 59) were randomly selected to achieve a sample size comparable to the elderly. Evaluation of depressed mood was determined by Beck Depression Inventory. MAIN OUTCOME MEASURES: Multidimensional Pain Inventory, Pain Disability Index, Pain Duration, Work-Related Disability, Medication Use, and Pain Severity. RESULTS: A high prevalence of dysphoria was found in both age groups. No significant differences were found between age and depressed mood. The only significant association between depressed mood and age occurred with pain duration, with the elderly experiencing fewer total hours per day in pain. Combining age groups, multivariate analysis of variance revealed that dysphoric chronic pain patients reported more antidepressant use, greater pain intensity, greater interference due to pain, and less life control than the nondepressed patients. Interference in activities demonstrated the strongest relationship with depressed mood in both age groups. CONCLUSIONS: There is a high prevalence of dysphoria in both the elderly and nonelderly with chronic back pain. The relationships between pain-related constructs and depressed mood in chronic back pain patients are similar in the elderly and nonelderly. The impact of the pain experience on the individual's activities, functioning, and feelings of life control should be considered in theoretical and clinical explanations of the association between pain and depression.

Adult↗
PubMed1993

Psychological characteristics and DSM-III-R diagnoses at 6-year follow-up of adolescent anorexia nervosa.

OBJECTIVE: To examine the relationship between psychiatric disorder and psychological characteristics at 6-year follow-up of adolescent-onset anorexia nervosa. METHOD: Twenty-three subjects were interviewed by telephone using the Structured Clinical Interview for DSM-III-R diagnosis. These subjects and 23 demographically similar controls completed standardized questionnaires that assessed their defense and coping styles, level of depression, defensiveness, and eating disorder psychopathology. RESULTS: Of the anorexic subjects 35% had no DSM-III-R diagnosis, 43% an eating disorder, (9% anorexia nervosa, 17% bulimia nervosa, 22% eating disorder not otherwise specified), 30% an affective disorder, and 43% an anxiety disorder at follow-up. Factors at presentation associated with good outcome included greater use of mature defenses, less depression, and a lower drive for thinness. Psychological characteristics of anorexic subjects with good outcome resembled those of controls except that the former anorexics expressed greater dissatisfaction with their bodies and reported less use of cognitive avoidance as a coping mechanism. Anorexic subjects with continuing psychiatric problems differed from controls on most of the measures studied. CONCLUSIONS: Distribution of psychiatric disorders at follow-up is similar for adolescent and adult-onset anorexia nervosa. Self-report measures of some psychological characteristics are useful prognostic indicators. Absence of psychiatric disorder at follow-up is associated with normalization of many psychological characteristics.

Adaptation, Psychological↗
PubMed1993

Safety and antiplatelet effect of murine monoclonal antibody 7E3 Fab directed against platelet glycoprotein IIb/IIIa in patients undergoing elective coronary angioplasty.

BACKGROUND: Excessive platelet deposition at the site of arterial damage due to coronary angioplasty plays an important role in the pathophysiology of both abrupt closure and restenosis after that procedure. Even aspirin, a relatively weak platelet antagonist, decreases the complications of coronary angioplasty. This study was designed to provide preliminary safety and efficacy data on the use of a much more powerful antiplatelet agent, m7E3 Fab, a prototype murine monoclonal antibody fragment that binds directly to the platelet glycoprotein IIb/IIIa receptor mediating aggregation in patients undergoing coronary angioplasty. METHODS: Twenty-three patients referred for elective coronary angioplasty who met prespecified criteria designed to minimize risk of bleeding received, in groups of four to six patients, escalating bolus doses of 0.15 to 0.35 mg/kg of this agent immediately before coronary angioplasty. Heparin was administered in the usual manner, but aspirin was withheld for 24 hours before coronary angioplasty and until bleeding times and platelet aggregation had returned to normal after angioplasty. Glycoprotein IIb/IIIa binding site occupation, platelet aggregation response to 20 microM of adenosine diphosphate, and data on bleeding times were acquired at baseline and at 2, 6, 24, 48 and 72 hours after m7E3 Fab administration. Clinical safety and efficacy were also monitored throughout the time of hospitalization, and delayed antimurine immune responses were assayed. Five similar patients received aspirin (325 mg orally per day) but otherwise received the same treatment, thus serving as controls. RESULTS: Treatment with m7E3 Fab resulted in a dose-dependent occupation of binding sites to a maximum of 93% at 2 hours in the highest-dose groups, with an associated graded inhibition of platelet aggregation and increase in bleeding time significantly exceeding that seen in control patients, with a gradual recovery over 6 to 48 hours. Percutaneous transluminal coronary angioplasty was successfully performed in 18 of 21 patients (86%) in whom it was attempted. Arterial and venous sheath removal 24 hours after m7E3 Fab dosing was largely uneventful. No thrombotic complications were seen, and only one patient (excluding a patient who underwent uneventful urgent bypass surgery) had bleeding severe enough to require packed red cell transfusion. Eight patients (36%) developed late antibody titers against m7E3 Fab. CONCLUSIONS: This murine monoclonal antibody provides potent antiaggregatory action and thus may be useful in preventing thrombotic complications of coronary angioplasty, but studies of its safety and efficacy during longer infusions and with larger numbers of patients are needed. Less immunogenic forms of the antibody may be more clinically useful.

Angioplasty, Balloon, Coronary↗
PubMed1993

Generation of cohesive ends on PCR products by UDG-mediated excision of dU, and application for cloning into restriction digest-linearized vectors.

We have investigated the use of dU excision by uracil N-glycosylase (UDG) to create cohesive ends on PCR fragments "mimicking" those generated by restriction enzymes. The feasibility of this approach for directional and nondirectional cloning using cohesive ends mimicking SacI or PstI ends is demonstrated by the subcloning of a 383 to 388-bp fragment of bovine basic fibroblast growth factor into restriction enzyme-linearized pT7T318U. UDG-mediated cohesive ends imperfectly matched to PstI-generated vector ends gave reasonable cloning efficiency and accuracy, suggesting that the approach may be extended to mimicry of other restriction enzymes producing 3' overhangs. The rapid and specific excision of dU by UDG (within 30 min at 37 degrees C) has several potential advantages over the use of restriction site-modified primers, including the avoidance of restriction cleavage at internal sites within the PCR product. Also, following ligation, the approach described may be used to prevent subsequent cleavage of the joined DNA segments by the restriction enzyme, that is, by not recreating the restriction enzyme recognition sequence at the junction, which may find application in gene engineering. By adapting the approach to use dU-containing linkers or "vectorettes," the approach may be used for cloning unknown sequences (e.g., by cDNA or genomic library construction) or for mimicking 5' overhang cohesive ends on PCR fragments.

Animals↗
PubMed1993

Warning! Schools can damage your health: alienation from school and its impact on health behaviour.

An international study of health behaviour among school-age children was co-ordinated by the World Health Organization (WHO). The data were obtained from a self-completion questionnaire examining key health behaviours and associated psycho-social variables obtained from representative samples of young people in school aged 11.5, 13.5, and 15.5 years. The analysis focuses on the relationship between older (15.5 years) students' attitudes towards school and health behaviours such as regular smoking, alcohol use, physical activity and food choices. The data show a strong and progressive relationship between indicators of 'alienation' from school, and health compromising behaviours among school students from Australia and Wales. This relationship is most obvious with the 'abusive' behaviours of smoking and alcohol misuse. Summary data for nine other countries in the WHO study indicate that this relationship is found consistently across all countries in the study. This substantial minority of students (approximately 30% varying between countries) represents an important target population for efforts to promote healthy lifestyles. Traditional school health education is seen as insufficient to tackle this task and recommendations are made concerning change to the school environment and ethos, and the need to reach young people in their home and community settings.

Adolescent↗
PubMed1993

Developmental changes in tau phosphorylation: fetal tau is transiently phosphorylated in a manner similar to paired helical filament-tau characteristic of Alzheimer's disease.

Rat and human fetal brain tau were probed with a panel of monoclonal antibodies (tau-1, AT8, 8D8, RT97, SMI31, SMI34) that distinguish between paired helical filament (PHF)-tau of Alzheimer's disease and normal adult brain tau. These antibodies discriminate between normal and PHF-tau because their epitopes are phosphorylated in PHF-tau. Although only one molecular isoform of tau was shown to be expressed in fetal brain, two fetal tau species could be distinguished on sodium dodecyl sulfate-polyacrylamide gel electrophoresis and the slower migrating species was recognized by all of the PHF-tau-specific antibodies. Moreover, this immunoreactivity was shown to be phosphorylation dependent. Our observations suggest that the abnormal phosphorylation of tau in Alzheimer's disease may be the result of reactivation of pathways governing the phosphorylation of tau in the developing brain.

Adult↗
PubMed1993

Laser induced fluorescence identification of sinoatrial and atrioventricular nodal conduction tissue.

UNLABELLED: Transcatheter ablation of nodal tissue is used for the treatment of arrhythmia resistant to medical therapy. We have investigated the use of laser induced fluorescence spectroscopy for the in vitro recognition of nodal conduction tissue. Twelve fresh human necropsy specimens (< 48 hours) were obtained from sinoatrial node and atrioventricular node areas. Spectra were recorded during excitation at 308 nm (XeCl excimer laser, 1.5-2.0 mJ/pulse, 10 Hz). Ech area examined was marked for subsequent histologic examination. Four hundred eleven spectra were obtained, of which 37 contained nodal conduction tissue (21 sinoatrial, 16 atrioventricular node). Normalized fluorescence emission intensity from these areas was compared with that of surrounding endomyocardial tissue at 18 wavelengths and 35 ratios of fluorescence intensity at selected wavelengths. Spectra recorded from nodal tissue could be clearly distinguished by a visible decrease in fluorescence emission intensity at wavelengths from 440 to 500 nm (P < 0.0006 at 450 nm), peak area, and peak width when compared to that of adjacent atrial endomyocardial tissue. Nodal conduction tissue was also distinguished from ventricular endocardium (14 spectra) by an increase in fluorescence emission at 430 to 550 nm (P < 0.0001). The specificity was 73% and 88% and the sensitivity was 73% and 60% for sinus nodal and atrioventricular nodal conduction tissue identification, respectively. A ratio of fluorescence emission intensity > 1.3 for 380/475 nm was able to detect nodal conduction tissue (P < 0.001). CONCLUSION: Laser induced fluorescence can differentiate nodal conduction tissue from atrial and ventricular endocardium and may provide a new diagnostic tool for the recognition and subsequent ablation of nodal conduction tissue.

Adolescent↗
PubMed1993

Antifungal properties in a novel series of triazino[5,6-b]indoles.

GR99060 and GR99062 are representatives of a series of 1,2,4-triazino[5,6-b]indole compounds. This series possessed broad-spectrum antifungal activity in vitro. The MIC ranges of the two compounds were as follows: 0.25 to 4 micrograms/ml for Candida albicans, 0.25 to 16 micrograms/ml for Candida sp., 1 to 8 micrograms/ml for Aspergillus spp., and 0.25 to 16 micrograms/ml for Cryptococcus neoformans. GR99062 was metabolized in vitro by a mouse liver microsomal preparation, while GR99060 was stable. GR99060 was efficacious in a murine model of systemic candidiasis by oral or parenteral administration, although no clear dose-response was achieved, suggesting that other factors adversely affected the compound's in vivo activity.

Animals↗
PubMed1993

Growth and clinical course of children with Crohn's disease.

Growth impairment is a common complication of childhood Crohn's disease, but longitudinal data and follow up studies into adulthood are sparse. This study reviewed the records of 100 Tanner stages 1 and 2 children (66 males, 34 females) consecutively diagnosed with Crohn's disease at this hospital between January 1980 and June 1988. The influence of sex, anatomical location of disease, severity of symptoms, corticosteroids, and surgical intervention on growth were analysed by univariate and multivariate regression analysis. At diagnosis mean standard deviation score (SDS) for height was -1.11 (1.28) (males -1.14 (1.26), females -1.05 (1.33)). Twenty one children were below the third centile for height. During years one and two height velocity (cm/y) was 4.4 (2.3) and 5.1 (2.7), but 40% of children in year one and 33% of children in year two grew less than expected (< 4 cm). Forty nine children grew < 4 cm/y during two or more of the 4.9 (1.8) years of follow up. Severity of gastrointestinal symptoms was the major factor influencing linear growth velocity (p < 0.01 for years one and two). Despite the high prevalence of growth impairment, the subset of children who had reached maturity by the time of the study (n = 67) nevertheless maintained their height centile. The SDS for height at ultimate follow up was -0.82 (1.1). Compared with diagnosis, change in SDS was +0.35 (1.08). Growth increments were comparable for surgically treated patients v patients only treated medically and among patients stratified by location of disease. Females (n = 25) achieved greater catch up growth than males (n = 42). Ultimate SDS for height for females was -0.48 (0.91) v -1.02 (1.19) for males. Change in SDS for height was +0.66 (1.27) for females v +0.16 (0.90) for males (p=0.02). These data confirm the frequency of growth impairment in childhood Crohn's disease. After diagnosis, however, the prognosis for ultimate linear growth is good.

Adolescent↗
PubMed1993

Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.

STUDY OBJECTIVE: To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes. DESIGN: Semistructured interviews of health promotion managers. SETTING: Wales and two reference health regions in England. PARTICIPANTS: Nine health promotion managers in Wales and 18 in England. MEASUREMENTS AND MAIN RESULTS: Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas. CONCLUSION: Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended.

Cardiovascular Diseases↗
PubMed1993

Cerebrospinal fluid diversion procedures in pseudotumor cerebri.

We reviewed the efficacy of CSF diversion for pseudotumor cerebri (PTC) in patients from six different institutions. Thirty-seven patients underwent a total of 73 lumboperitoneal shunts and nine ventricular shunts. Only 14 patients remained "cured" after a single surgical procedure. The average time between shunt insertion and shunt replacement was 9 months, although 64% of shunts lasted less than 6 months. Shunt failure (55%) and low-pressure headaches (21%) were the most common causes for reoperation. The vision of most patients improved (13) or stabilized (13) postoperatively. However, three who had initially improved subsequently lost vision. Six had a postoperative decrease in vision. Two patients improved in one eye but worsened postoperatively in the other. Four lost vision despite apparently adequate shunt function. Shunt failure with relapse of PTC occurred as late as 7 years after insertion. CSF diversion procedures have a significant failure rate as well as a high frequency of side effects.

Cerebrospinal Fluid Shunts↗
PubMed1993

Correlation of proto-oncogene expression and proliferation and meningiomas.

Proliferation and proto-oncogene expression in 19 meningiomas of typical and atypical histology were analyzed in an attempt to understand the mechanism of growth that characterizes the neoplastic process in these tumors. Proliferation was estimated as the proliferative index by the enumeration of S-phase cells in imprints of tumor tissue exposed to bromodeoxyuridine in vitro, and the gene expression of c-myc, c-fos, c-src, c-H-ras, N-myc, acidic and basic fibroblast growth factor, insulin-like growth factors I and II, platelet-derived growth factor-alpha, and epidermal growth factor was quantified by messenger ribonucleic acid dot-blot hybridization assay. Atypical and malignant tumors had significantly higher proliferative indexes than did their nonmalignant counterparts. Levels of c-myc and c-fos messenger ribonucleic acid were elevated more than fivefold in 72 and 78% of the tumors, respectively, relative to the lowest levels detected in the series. Levels of growth factor messenger ribonucleic acid were sporadically elevated; 37 to 44% of tumors had more than fivefold enhanced levels of acidic and basic fibroblast growth factor. Positive correlations between proliferation and proto-oncogene/growth factor expression were found for c-myc in atypical/malignant tumors and for epidermal growth factor in fibroblastic meningiomas. Deregulated expression of c-myc and c-fos common to both typical and atypical tumors suggests that these are early events in the meningioma tumor process that may disturb the control of cell differentiation and together with fibroblast growth factors are likely to endow the transformed cell with a selective growth advantage by reducing the requirement for exogenous mitogens and by providing a niche for the growth of the tumor clone. Positive correlation of c-myc levels with proliferation in atypical/malignant meningiomas implies that this is a feature of malignancy and indicates continued disruption of the negative regulation of proto-oncogene expression, perhaps by tumor suppressor gene losses, during the course of tumor progression.

Cell Division↗
PubMed1993

The effect of selection in sublines and crossing on genetic response and inbreeding.

More intense selection in a line gives greater genetic change but also gives a higher rate of inbreeding. Here, continuous selection in one line vs continuous selection in two or more sublines (for the same breeding objective and with the same total number of individuals tested) and crossing the sublines to reduce inbreeding, is studied by stochastic simulation using an infinitesimal model. On crossing, the inbreeding level in the cross, though zero, becomes equivalent to 1/n times that in the sublines, where n is the number of lines in the cross. In general, selecting in sublines and crossing gave less genetic response at the same level of inbreeding than selection in a single line. Use of the best subline generally gave less response than the whole line. It is concluded that selection response at the same level of inbreeding is greatest when all the test facilities and selection are concentrated in a single selection line.

Animals↗
PubMed1993

Lipid peroxidation in hyperlipidaemic patients. A study of plasma using an HPLC-based thiobarbituric acid test.

The question of "increased lipid peroxidation" in plasma from hyperlipidaemic patients was investigated using an improved HPLC-based assay for thiobarbituric acid-reactive material. Levels of TBARS in healthy human controls were at or close to zero, provided that butylated hydroxytoluene was added to the sample with the TBA reagents. Levels of plasma TBARS in hyperlipidaemic patients were elevated, although the absolute levels were much lower than those reported previously in the literature.

Adult↗
PubMed1993

Factors associated with airway colonisation and invasion due to Klebsiella spp.

The clinical significance of a heavy growth of Klebsiella spp. in sputum was studied in 54 patients. All but 3 patients had significant factors potentially associated with respiratory tract colonisation or invasion. Risk factors identified for colonisation of the airway and for invasive disease were similar. Patients with community-acquired Klebsiella infections were more likely to have underlying chronic respiratory diseases. Prior antibiotic use was a risk factor for nosocomial infections which occurred more commonly with antibiotic-resistant organisms. The most common diagnoses were airway colonisation, acute community-acquired chest infections, and nosocomial chest infections. Primary acute community-acquired pneumonia was uncommon. The sensitivity and specificity of the sputum Gram stain (in the setting of positive sputum cultures) in suggesting the presence of invasive disease due to Klebsiella spp. were 42% and 69% respectively.

Adolescent↗
PubMed1993

Capacity building and resource needs of state health agencies to implement community-based cardiovascular disease programs.

State Health Agencies play a critical role in the Nation's efforts for health promotion and disease prevention. This role is especially critical in efforts to reduce the burden of CVD through community-based programs. Resources SHAs need to facilitate implementation of community-based CVD prevention programs fall into three general categories: (a) Adequate time to plan, carry out and evaluate, (b) Financial resources to support staff, community organization and demonstration programs, and (c) Personnel with requisite technical expertise, skills and technological resources. Six critical activities for building state-level CVD program capacity include: (1) Forming a statewide CVD oversight committee, (2) Developing a state CVD plan, (3) Developing quality assurance standards and guidelines, (4) Developing new paradigms of community assessment and evaluation, (5) Planning for institutionalization, and (6) Translation of research to application. SHA roles vary from direct service delivery to serving as a linking agent, transferring information and resources and coordinating efforts between agencies.

Cardiovascular Diseases↗
PubMed1993

Appearances of the postoperative alimentary tract.

In summary, patients who have had alimentary tract operations are looked upon by most radiologists as a travail rather than a challenge. This article has reviewed common operations and has given some definite guidelines to ensure accurate radiologic diagnoses of patients who have had even complicated alimentary tract surgery.

Digestive System↗