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Biomedical subjects

D Edwards

Publications and source records attributed to D Edwards.

At least 91 records · Page 5Linked to original sources
PubMed1993

Outcome at twelve months of adjusted age in very low birth weight infants with lung immaturity: a randomized, placebo-controlled trial of human surfactant.

We compared the neurodevelopmental outcome of extremely premature, surfactant-deficient infants who received either prophylactic surfactant at birth, "rescue" surfactant after the clinical diagnosis of respiratory distress syndrome was established, or placebo. Infants studied were participants in a randomized, bicenter (San Diego, Calif., and Helsinki, Finland), controlled trial of human surfactant therapy. One hundred fifty infants (prophylaxis group, 63 infants; rescue group, 57; placebo group, 30) were prospectively enrolled at 38 weeks of gestational age. There were no neonatal intergroup differences in the incidence or severity of sonographic central nervous system abnormality or retinopathy. One hundred forty-five infants were alive at 1 year of adjusted age, at which time growth, neurosensory, and neurologic outcome were similar in all three treatment groups at both centers. Cerebral palsy occurred in 20% overall. Five infants (3.5%) were functionally blind. However, infants treated at birth had lower mean mental and motor scores on the Bayley Scales of Infant Development compared with those of infants rescued with surfactant after the onset of respiratory distress syndrome (Mental Development Index: 78 vs 96, p = 0.02; Psychomotor Development Index: 73 vs 87, p = 0.04). Chronic lung disease occurred more frequently in the prophylactically treated group and contributed to the subjects' neurologic and developmental morbidity. Because prophylactic surfactant treatment offered no neurodevelopmental advantage and may contribute to poorer outcome, we currently recommend early surfactant replacement only for those infants who have postnatal evidence of respiratory distress syndrome.

Brain↗
PubMed1993

Arthroscopic diagnosis and treatment of septic arthritis of the hip joint.

Septic arthritis of the hip joint can be difficult to detect clinically and usually requires a formal arthrotomy for adequate drainage and debridement of the joint. This case report presents a patient for whom the diagnosis and treatment were performed arthroscopically. This technique allows isolation of the organism as well as the opportunity to irrigate, lavage, and debride the joint through a small puncture wound only.

Adult↗
PubMed1993

Plastic surgery applicants in 1992.

All the applicants to plastic surgery residency programs who participated in the residency matching program for 1992 were reviewed. Data were collected on age, sex, race, nationality, place of birth, undergraduate education, medical education, postgraduate training, research activity, and evaluation scores. Findings indicate that applicants interested in academic careers are significantly more likely to have published research and are generally rated higher in categories of intellectual curiosity, performance, and intelligence by evaluators. Women and some minorities were underrepresented when compared with recent medical school graduating classes. We recommend a longitudinal study of applicants to correlate career achievement with applicant characteristics. We also recommend some changes in the application and evaluation process and in efforts to interest women and minorities in the specialty.

Adult↗
PubMed1993

Stimulated eosinophils and proteinases augment the transepithelial flux of albumin in bovine bronchial mucosa.

1. The apical to basolateral transmucosal flux of albumin has been measured in isolated sheets of bovine bronchial and tracheal mucosa. Under resting conditions the net unidirectional flux in the bronchial mucosa was not significantly different from that measured previously for the basolateral to apical vector. In contrast, the apical to basolateral flux in the tracheal mucosa was significantly lower than that measured in the opposite direction. 2. Addition of guinea-pig peritoneal eosinophils to the apical side of the tissues had no significant effect on the transmucosal flux of albumin in either the bronchial or tracheal mucosa. 3. When eosinophils were stimulated with the ionophore A23187 or by opsonic adherence to tissues treated with a guinea-pig anti-bovine airway epithelium antibody, the bronchial mucosal sheets that had been exposed showed a significant increase in the transmucosal flux of albumin. However, tissues from the tracheal mucosa were resistant to the effects of stimulated eosinophils. 4. Histologically, sheets of mucosa from bovine main bronchi that had been exposed to stimulated eosinophils were characterized by epithelial injury consisting of loss of columnar epithelium from the underlying basal cell layer and biomatrix. Much less evidence of cellular injury was observed in tracheal tissues. 5. Bacterial collagenases applied to the apical side of the sheets were shown to increase the permeability of the bronchial mucosa to albumin and to produce histological changes that had similarities with the pattern of damage produced by stimulated eosinophils. 6. These observations demonstrate that the ability of eosinophils to injure the bronchial mucosa is independent of the side of the tissue on which they are present. Furthermore, key aspects of the injury process may be reproduced, at least in part, by metalloproteinases.

Albumins↗
PubMed1993

Driving performance in persons with mild senile dementia of the Alzheimer type.

OBJECTIVE: To assess the effect of mild senile dementia of the Alzheimer type (SDAT) on driving ability. DESIGN: Cross-sectional study with correlation analysis. SETTING: A university-based Alzheimer's Disease Research Center, which evaluates community-living older adult volunteers, and the university's Program in Occupational Therapy. PARTICIPANTS: Healthy elderly controls (n = 13) and subjects with very mild (n = 12) and mild (n = 13) SDAT. Dementia severity was staged by the Washington University Clinical Dementia Rating. MEASUREMENTS: The driving ability of participants on the in-car road test was scored independently by a driving instructor, blinded to the study design and to the dementia status of the subjects, and an unblinded occupational therapist. Interview-based perceptions of driving ability were obtained independently from the subjects and their collateral sources. Attentional and visuospatial performances of the subjects were assessed prior to the road test. RESULTS: All control and very mild SDAT subjects were judged to be "safe" drivers (ie, passed the in-car road test), but five (40%) of the mild SDAT subjects had driving impairment sufficient to "fail" the road test. Neither subject self-assessment nor caregiver perceptions of driving ability consistently predicted driving performance. Attentional task performance correlated well with road test results. CONCLUSIONS: Some SDAT subjects retain "safe" driving skills. The greater the dementia severity, the greater the likelihood of poor driving ability. Performance-based (road test) evaluations are necessary to properly determine driving skills at present, but attention and other cognitive screening measures should be developed.

Aged↗
PubMed1993

Decreased norepinephrine turnover rate in the brown adipose tissue of pre-obese fa/fa Zucker rats.

Norepinephrine (NE) content and turnover rate, and the activity of dopamine-beta-hydroxylase (DBH) were measured in the brown adipose tissue (BAT) of developing Zucker rats of the three genotypes: Fa/Fa and Fa/fa (with a lean phenotype) and fa/fa (phenotypically obese). As early as 15 days of age, namely at a pre-obese stage, BAT NE content and turnover rate are already reduced in fa/fa rats, just like they are at 50 days. The development of DBH activity is completely impaired in fa/fa rats. These results demonstrate that the reduction in sympathetic tone in BAT of fa/fa rats is already present before the onset of phenotypic obesity.

Adipose Tissue, Brown↗
PubMed1992

Clinical phenotype and molecular analysis of a three-generation family with an interstitial deletion of the short arm of chromosome 5.

We report on a 3-generation family with an interstitial deletion of the short arm of chromosome 5. Varied manifestations were found among the affected individuals including microcephaly, hypertonia, and micrognathia; mental retardation was common to all affected individuals. High resolution chromosome analysis was interpreted as del(5) (pter- > p14.3::p13.3- > qter). Molecular comparison of the deletion in this family with individuals with other 5p deletions suggests that the clinical findings are due specifically to the chromosomal material deleted from 5p13.

Abnormalities, Multiple↗
PubMed1992

Construction and characterisation of a yeast artificial chromosome library containing three haploid maize genome equivalents.

We have constructed a yeast artificial chromosome (YAC) library using high-molecular-weight DNA prepared from agarose-embedded leaf protoplasts of the maize inbred line UE95. This library contains 79,000 clones with an average insert size of 145 kb and should therefore represent approximately three haploid genome equivalents. The library is organised as an ordered array in duplicate microtitre plates. Forty-one pools of DNA from 1920 individual clones have been prepared for rapid screening of the library by the polymerase chain reaction (PCR). Using this approach, together with conventional colony hybridisation, we have been able to identify between one and eight positive clones for every probe used.

Chloroplasts↗
PubMed1992

The role of computed tomography (CT) in the investigation of unexplained haemoptysis.

Forty patients with a history of haemoptysis, normal chest radiographs apart from evidence of chronic airflow limitation, and normal fibreoptic bronchoscopy (or blood alone in the bronchial tree) were investigated by computed tomography (CT). Abnormalities were seen in 20 (50%) of the CT scans. Seven of the patients had evidence of bronchiectasis (18%), one of whom also had a mass. In four (10%) cases a mass alone was detected (two tuberculous, two malignant). In a further four (10%) scans alveolar consolidation was present and in three cases abnormal vessels were detected (7.5%). One patient had cystic changes shown in their scan and multiple nodules were shown in the final patient. The contralateral lungs of 93 patients undergoing CT for pre-operative assessment of bronchogenic carcinoma were used as controls. In six (6%) of these patients abnormalities were detected by CT. Pleural nodules were observed in two patients, fat in the transverse fissure in another, atelectasis in two patients and an apical bulla in the other abnormal scan. The relative risk for patients with unexplained haemoptysis having abnormal CT scans compared to the control group of patients was 7.75. We conclude that computed tomography is of value in the investigation of patients with unexplained haemoptysis.

Adult↗
PubMed1992

Effect of physiotherapy on the auditory evoked response of paralysed, sedated patients in the intensive care unit.

Auditory evoked response (AER) was recorded before, during and after physiotherapy in 11 paralysed (atracurium 0.56 (SD) 0.13 mg kg-1 h-1), sedated (propofol 2.2 (1.0) mg kg-1 h-1; fentanyl 4.4 (2.3) micrograms kg-1 h-1) and critically ill patients undergoing ventilation in the intensive care unit (ICU). The latency of the negative wave, NB, was reduced by physiotherapy (mean 44.8 (SD) 7.9 ms before, 41.0 (6.8) ms during (P less than 0.01, non-parametric Friedman test) and 45.6 (6.3) ms after physiotherapy); NB amplitude showed no consistent change (-0.81 (1.4) microV, -0.81 (1.5) microV and -0.71 (1.3) microV, respectively). NB latency responded to patient arousal at constant levels of sedation and this requires further evaluation as a means of monitoring sedation in paralysed patients in the ICU.

Adult↗
PubMed1992

Upper extremity impairment in workers performing repetitive tasks.

A series of subjective and objective measures were chosen to determine impairment of upper extremity function in 157 workers performing repetitive tasks. Workers were asked to respond to questions regarding their perception of the presence or absence of numbness, pain, weakness, or swelling in their upper extremities. Objective tests consisted of the measurement of grip strength, pinch strength, Semmes-Weinstein monofilament sensory responses, vibrometer responses, neurometer measurement, and the presence or absence of Tinel's or Phalen's signs. These measures were considered collectively to estimate the overall levels of impairment of each individual. Overall findings show that 55 percent of workers examined had impairment scores of 2 or more and 75 percent had scores of 1 or more. Significant differences were found in impairment ratings between job types. Those jobs requiring the highest repetition with the least rest per cycle had the highest impairment ratings. Workers that rotated jobs had impairment scores significantly less (p less than 0.005) than the average of workers performing single-task jobs. We conclude that cumulative trauma disorders are more prevalent than originally believed and that the disorder is best examined from an overall functional impairment perspective.

Adult↗
PubMed1992

Gestational changes in Ca2+ transport across rat placenta and mRNA for calbindin9K and Ca(2+)-ATPase.

The unidirectional maternofetal clearance (Kmf) of 45Ca was measured across the rat placenta over the last one-third of gestation. Kmf for 45Ca normalized to its diffusion coefficient in water (Kmf/Dw) increased 72-fold between days 15 and 22 of gestation from 3.5 +/- 0.3 to 253.1 +/- 22.0 cm/g placenta, respectively. At 15 and 18 days of gestation, Kmf/Dw for 45Ca was similar to Kmf/Dw for the paracellular marker [14C]mannitol, but at 21 and 22 days of gestation, Kmf/Dw for 45Ca was significantly higher than Kmf/Dw for [14C]mannitol, indicating that an additional route of transfer, other than diffusion, becomes available to calcium during this period. Northern hybridization analysis demonstrated that rat placental calbindin9K-to-beta-actin mRNA ratio increased 135-fold between 15 and 22 days of gestation and was temporally associated with the gestational increase in Kmf/Dw for 45Ca. In contrast, rat placental Ca(2+)-ATPase-to-beta-actin mRNA ratio increased only two- to threefold over the same gestational period and did not mirror the gestational changes in calcium clearance. These trends suggest that the expression of placental calbindin9K, but not Ca(2+)-ATPase, may be rate limiting to placental calcium transport in the rat.

Actins↗
PubMed1992

A consumer-operated case management project.

The idea that patients and former patients might themselves be involved in service delivery has become increasingly popular in recent years. Once viewed as an expression of patient protest without clinical merit, self-help services are now, at least in some places, accepted and endorsed by mental health planning authorities. This month's guest columnists describe the philosophical underpinnings of a state-funded consumer-operated case management program in Oregon and discuss both the hope and some of the potential difficulties that such an experimental effort may generate.

Activities of Daily Living↗
PubMed1992

Umbilical artery velocimetry in predicting perinatal outcome with intrapartum fetal distress.

The aim of this study was to see whether umbilical artery Doppler velocimetry predicts intrapartum fetal distress evidenced by poor perinatal outcome. Umbilical velocimetry was performed on 102 parturients with a presumptive diagnosis of fetal distress based on fetal heart rate (FHR) patterns. A mean systolic-diastolic ratio (S/D) of 3 or more after 30 weeks' gestation was considered abnormal. Poor perinatal outcome was defined by any of the following: small for gestational age, low Apgar score, acidosis, meconium below the vocal cords, prolonged neonatal hospital stay, neonatal intensive care unit admission, and neonatal morbidity. Eighty-two patients had normal S/Ds and 20 had abnormal ratios. Eighteen neonates (90%) in the abnormal-SD group had at least one adverse outcome, compared with only 13 (15.8%) of those with a normal S/D, a statistically significant difference (P less than .001). Umbilical artery S/D used as a screening tool to detect poor perinatal outcome had a sensitivity of 65-100%, specificity of 83-92%, positive predictive value of 20-81%, negative predictive value of 91-100%, and a kappa index of 0.24-0.63. These findings suggest that umbilical artery Doppler velocimetry may be useful as an adjunct in the assessment of intrapartum FHR patterns suggesting fetal distress.

Adult↗
PubMed1991

Factors affecting the normal and branched-chain acyl moieties of teicoplanin components produced by Actinoplanes teichomyceticus.

Teicoplanin, a glycopeptide antibiotic produced by Actinoplanes teichomyceticus, comprises five main components, denoted T-A2-1 to T-A2-5, differing in the structure of their acyl side chain, which is linear in T-A2-1 and T-A2-3 and branched in the other components. Production of T-A2-1, characterized by a linear C10:1 acyl moiety, is entirely dependent on the presence of linoleate in the fermentation medium. Addition to the medium of oleic acid esters at 2 g l-1 increases the yields of T-A2-3, characterized by a linear C10:0 acyl chain, about threefold. The antibiotic linear side chains thus appear to originate from C18 unsaturated acid by beta-oxidation degradation. The percentage of T-A2-2, T-A2-4 and T-A2-5, bearing the iso-C10:0, anteiso-C11:0 and iso-C11:0 acyl moieties, respectively, is strongly influenced by the presence in the medium of the amino acids known to be precursors of branched-chain fatty acids. Thus, valine increases the production of T-A2-2 whereas isoleucine or leucine increase the relative yields of T-A2-4 or T-A2-5, respectively. Analysis of the total cell lipids upon addition of the same amino acid shows corresponding increases in the proportion of the iso-C16:0, iso-C15:0 or anteiso-C17:0. A mutant A. teichomyceticus strain, which produces a novel teicoplanin with a linear C9:0 chain, differs from the wild strain in the presence of the linear C17:1 acid in its lipids.(ABSTRACT TRUNCATED AT 250 WORDS)

Acylation↗