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Biomedical subjects

D H Wilson

Publications and source records attributed to D H Wilson.

At least 37 records · Page 2Linked to original sources

Analysis of TCR beta chains in Lewis rats with experimental allergic encephalomyelitis. II. Vbeta8.2+ T cells with limited CDR3 N region additions derive from the adult thymus.

Immunization of Lewis (LEW) rats with guinea pig myelin basic protein (MBP) induces a population of encephalitogenic CD4 T cells having specificity for the dominant immunogenic peptide of MBP, 68-86. The TCR beta chains of these disease-causing T cells show three distinct features: they are almost exclusively Vbeta8.2, they use AspSer as the first two amino acid residues of the third complementarity-determining region (CDR3) and these junctional region sequences show few if any non-germline N-region nucleotide additions. This last feature raises the possibility that these autoimmune T cell precursors derive from TCR gene rearrangements occurring during early, perinatal ontogeny, a period when the enzyme terminal deoxynucleotidyl transferase (TdT), responsible for N region additions, is not expressed. An alternative possibility is that these features of the TCR of MBP 68-86-reactive T cells are dictated by considerations of antigen selection throughout ontogeny both in the thymus and in the periphery--ie., that such beta chains are conformationally the most appropriate for triggering by an epitope of 68-86 complexed to class II RT1.BI MHC molecules. We show here that active experimental allergic encephalomyelitis, while delayed in onset, occurs in heavily irradiated animals, but not in the absence of a thymus, a finding indicating that this autoimmune disease is caused by a T cell subpopulation derived from the post-irradiation adult thymus. These disease-causing T cells are heavily Vbeta8.2+, CDR3 AspSer+ and use few N region additions. We conclude that T cells with these TCR beta chain features can be generated in the adult thymus and most likely reflect requirements imposed by antigen selection.

Animals↗

Acquired thymic tolerance and experimental allergic encephalomyelitis in the rat. I. Parameters and analysis of possible mechanisms.

Intrathymic injection of guinea pig myelin basic protein (MBP) or the immunodominant, encephalitogenic fragment of MPB, 68-86, without otherwise compromising the peripheral lymphocyte pool in adult LEW rats, dramatically inhibits onset of experimental allergic encephalomyelitis (EAE) caused by the usual peripheral inoculation with MBP in complete Freund's adjuvant. This surprising finding demonstrates that interaction of antigen and one or more components of an intact thymus can down-regulate systemic responses by mature T cells already existing in the peripheral lymphocyte pool. How this happens is not known. In studies designed to explore possible mechanisms: (a) adult thymectomized animals remain susceptible to active EAE, thus EAE cannot be attributed solely to recent thymic emigrants that might be inactivated by antigen deposited in the thymus; (b) heterotopic isografts of injected thymic lobes transfer thymic tolerance to secondary recipients, thus the tolerance effect is dominant over an intact, non-treated thymus; (c) T cells from made thymic tolerant but not immunized donors are less effective in causing EAE following adoptive transfer into, and active immunization of, secondary, irradiated recipients; and (d) animals resistant to active EAE as a consequence of thymic tolerance are fully vulnerable to adoptive EAE caused by already activated MBP-specific T cell subpopulations. These results rule out a possible mechanism previously proposed for acquired thymic tolerance, i. e., that potentially pathogenic T cells traffic to the antigen-injected thymus where they are inactivated or eliminated.

Adoptive Transfer↗

Differences in health estimates using telephone and door-to-door survey methods--a hypothetical exercise.

Telephone interviewing is increasingly being used to obtain data on health issues. Propertly applied telephone interviewing may have considerable cost benefits, but careful thought has to be put into the design of surveys, weighting and analysis of data to avoid major sources of bias. This study is a hypothetical exercise comparing health estimates from a systematic, self-weighting, multistage, clustered, area sample of households using a face-to-face interview method, with hypothetical samples of people obtained from Random Digit Dialling and Electronic White Pages. In a comparison of the population health estimates obtained for a number of health problems in a hypothetical analysis of these samples, the confidence intervals for the estimates overlapped. Since the estimates are not statistically significantly different, it appears that well-planned, appropriately weighted and analysed telephone surveys can be a less expensive way of obtaining health information, however, some caution is expressed in using this method.

Adolescent↗

Hormone replacement therapy: prevalence, compliance and the 'healthy women' notion.

BACKGROUND: The objective of this study was to assess the current trends of hormone replacement therapy (HRT) use, including rates of use, length of use, continuation rates and characteristics of users and non-users and to examine the hypothesis that 'healthy women' are more likely to be users of HRT. METHODS: Analysis was carried out of three representative South Australian population studies in 1991, 1993 and 1995 comprising 3019, 3004 and 3016 personal interviews, respectively. RESULTS: Current use (and ever-use) of HRT in all women aged 50 years and over rose from 13.2% (26.7%) in 1991, to 21.2% (31.9%) in 1993 and 26.0% (40.5%) in 1995. Highest use is now in the 55-59-year age group where, in 1995, current use was 50.9% and ever use was 69.0%. Median compliance rates with HRT rose from 24 months in 1991 to 60 months in 1995 for current users aged 50 years of age or above. The pattern of increasing use of HRT is not consistent across age groups. Analyses of the 1995 data show that, in contrast with increasing rates of current use in women over 55 years, there was no overall change in rates for women below this age. There were no statistically significant differences in health indicators, e.g. blood pressure, smoking, cholesterol levels or body mass index between users and non-users of HRT. However, users reported significantly higher rates of previous osteoporosis and hysterectomy. CONCLUSIONS: Prevalence rates of HRT use are increasing together with compliance rates and this may reflect increased confidence with HRT therapy. Users of HRT have an increased rate of mammography compared to non-users and this may contribute to earlier detection and, therefore, increased estimates of breast cancer in HRT users. There was no support from the 1995 data for a 'healthy women' hypothesis among HRT users.

Age Factors↗

Health status of hormone replacement therapy users and non-users as determined by the SF-36 quality-of-life dimension.

BACKGROUND: The objective of this study was to compare the health status of women who use and do not use hormone replacement therapy (HRT). METHOD: The 1994 South Australian Health Omnibus Survey (a population health interview survey) was used to administer the short form-36 health survey questionnaire (SF-36) to users and non-users of HRT. A representative sample of 813 women aged 40 years and older were interviewed. The response rate of the survey was 72.4%. Eight health dimensions of the SF-36 were measured: physical functioning, social functioning, role limitations owing to emotional problems, role limitations owing to physical problems, mental health, vitality, pain and general health. RESULTS: The mean score for all eight health dimensions was in the bottom 50% of the population for HRT users while non-users were in the upper 50%. Users of HRT had significantly poorer scores for physical limitations, body pain, general health, vitality, social functioning and mental health. CONCLUSION: Women who use HRT are less healthy than non-users when measured by a generic health status measure.

Adult↗

Rapid, automated assay for progesterone on the Abbott AxSYM analyzer.

We describe an automated assay for progesterone (P4) in human serum and plasma with the Abbott AxSYM random-access immunoassay analyzer. In this one-step competitive assay, P4 immobilized onto latex microparticles competes with sample P4 for binding to a conjugate of alkaline phosphatase (AP) and anti-P4 antibody. Total CVs ranged from 3.4% to 8.2% in multiple precision studies conducted according to the 20-day NCCLS EP5-T protocol. The detection limit (zero calibrator + 2 SD) was 0.10 microg/L across 36 experiments. Values for diluted samples were 83-116% of expected. Recovery of P4 added to serum specimens was 92-115%. Cross-reactivities with 43 natural and synthetic steroids were 0-6.3%. No significant interference was detected from bilirubin, protein, erythrocytes, hemoglobin, triglycerides, or cholesterol. In a multisite correlation study, AxSYM P4 results compared well with results from a commercial RIA method (n = 1156; r = 0.976; slope = 1.03; y-intercept = 0.04). Assay throughput is >80 tests per hour in batch mode, 60 tests per hour with mixed load list configurations.

Autoanalysis↗

Prevalence and cost of alternative medicine in Australia.

BACKGROUND: To determine the prevalence and cost of alternative medicines and alternative practitioner use in an Australian population. METHODS: We conducted a representative population survey of persons aged 15 or older living in South Australia, which required 3004 personal interviews. We assessed the rates of use and types of alternative medicine and therapists used by this population in 1993, and correlations with other demographic and medical variables. FINDINGS: The overall use of at least one non-medically prescribed alternative medicine (excluding calcium, iron and prescribed vitamins) was 48.5%. The users were more likely to be perimenopausal females, better educated, have a higher alcohol intake, be of normal weight and more likely to be employed than non-users. 20.3% of respondents had visited at least one alternative practitioner, most commonly chiropractors (15%). The users of alternative practitioners were more likely to be younger, live in the country and be overweight. Women were more likely to consult naturopaths, iridiologists, and reflexologists than men. INTERPRETATION: Extrapolation of the costs to the Australian population gives a natural expenditure in 1993, for alternative medicines, of $621 million (Australian dollars) and for alternative therapists of $AU309 million per annum. This compares to the $AU360 million of patient contributions for all classes of pharmaceutical drugs purchased in Australia in 1992/93. The public health and economic ramifications of these huge costs are questioned in view of the paucity of sound safety and efficacy data for many of the therapies and products of the alternative medicine industry.

Adolescent↗

Changes in the use of hormone replacement therapy in South Australia.

OBJECTIVE: To determine changes in the use of hormone replacement therapy (HRT) in South Australia between 1991 and 1993. DESIGN AND SETTING: Survey of women aged 40 years and over, as part of the 1991 and 1993 South Australian Health Omnibus Surveys (household interviews); 868 were interviewed in 1991 and 790 in 1993. OUTCOME MEASURES: Rates of HRT use. RESULTS: In 1993, 19.0% of women aged 40 years and over were taking HRT and 28.5% had ever taken it (currently or in the past). The highest rates were in the 50-54 years age group (46.2% current use and 57.8% ever use). Between 1991 and 1993 there was a 40% increase in the number of women taking HRT and a significant increase (P < 0.01) in the median duration of therapy, from 38 to 54 months. There were also significant increases in rates of use by country women and Australian-born women (P < 0.01). Premarin and Provera remained the most commonly used products in 1993. CONCLUSION: Australian perimenopausal women are increasingly using HRT. This may reflect recent educational programs on the menopause for both health professionals and the public, and also an increasing number of choices of therapy.

Adult↗

Education and training of preregistration house officers: the consultants' viewpoint.

OBJECTIVE: To determine the opinions, attitudes, and requirements of consultants responsible for preregistration house officers in the light of the General Medical Council's Recommendations on General Clinical Training. DESIGN: A questionnaire was piloted asking 28 questions under the headings professional details, present training arrangements, effectiveness of current training, and perceived help required for implementing the recommendations. SETTING: Two teaching hospitals and nine district general hospitals in the Yorkshire region. SUBJECTS: 33 consultants (19 physicians, 14 surgeons) responded to an hour long interview. RESULTS: The traditional teaching ward round, with clinical meetings, was the main educational provision for house officers. Under a quarter of respondents provided specific teaching, which rarely exceeded 30 minutes weekly. Many delegated teaching to other junior or non-medical staff. Few consultants assessed the effectiveness of teaching, and feedback to juniors was rudimentary. There was strong support for the apprenticeship system and concern that it should not be downgraded. Appointing educational supervisors and introducing a structured educational programme were approved theoretically. Pressure on consultants to work faster, participate in audit and management, and accept financial responsibility for their clinical work, coupled with the reduction in junior doctors' hours, were considered to militate against educational developments. Many respondents felt frustrated and powerless. They would welcome an increased educational role but considered there must be conceptual, contractual, and financial changes. CONCLUSIONS: Fundamental changes are required by both consultants and management before the preregistration year can have proper educational value. Training in educational methods for consultants and a structured curriculum and formative assessment for trainees require recognition and financial support.

Attitude of Health Personnel↗

Fully automated assay of glycohemoglobin with the Abbott IMx analyzer: novel approaches for separation and detection.

We describe a novel assay for measuring glycohemoglobin directly from anticoagulated whole blood with the Abbott IMx analyzer. The glycohemoglobin is labeled with a soluble polyanionic affinity reagent and the anionic complex is then captured with a cationic solid-phase matrix. Glycohemoglobin is quantified by measuring the quenching by heme of the static fluorescence from an added fluorophore. The assay is standardized to report both percent total glycohemoglobin (%GHb) and percent hemoglobin A1c (%HbA1c). Glucose, bilirubin, triglycerides, labile fraction, and hemoglobin variants do not interfere in the assay. Within- and between-run CVs are approximately 4-5%, with total CVs of approximately 6.5%. Highly significant linear correlations (r > 0.97) were obtained in comparison studies with two major assay methodologies. The time to obtain one result is approximately 10 min (including assay of a control), 56 min for 22 results. We describe the development, standardization, and validation of this new method.

Autoanalysis↗

South Australian hypertension survey. General practitioner experiences with drug treatment.

OBJECTIVE: To investigate prescribing habits, educational approaches and perceived needs of general practitioners in the drug treatment of hypertension. DESIGN, SETTING AND PARTICIPANTS: Of 156 randomly selected South Australian general practitioners 132 responded to a questionnaire survey. MAIN FINDINGS: Diuretics are the most commonly chosen drug for the initial management of uncomplicated moderate hypertension. Equivalent patients aged 45, 60 and 75 years would be prescribed a diuretic as drug of first choice in 41%, 55% and 68% of cases respectively. Despite this, there are wide differences in the choice of initial therapy between individual practitioners. These differences can have a substantial cost impact, given that in Australia the cost of diuretic therapy for one month can be as low as $1.97 compared with $34.08 for standard angiotensin converting enzyme inhibitor therapy for one month. There was also a perceived need, and demand, for patient education materials to assist practitioners in the drug treatment of hypertension.

Adult↗

South Australian hypertension survey. General practitioner knowledge and reported management practices--a cause for concern?

OBJECTIVE: To survey South Australian general practitioners to investigate their knowledge and reported management of patients with hypertension. DESIGN, SETTING AND PARTICIPANTS: Of 156 randomly selected SA general practitioners 132 responded to a questionnaire survey. RESULTS: This survey showed substantial differences between general practitioners in their knowledge about hypertension and in their reported practices for diagnostic levels, investigations to be undertaken once diagnosis had been made, levels at which pharmaceutical treatment should be initiated, at which level treatment was regarded as having attained satisfactory control, and length of time for routine review. There was also a demand for materials to be provided to assist in the management of this important condition. CONCLUSIONS: There is a perceived need for better and more appropriate educational materials and a need for a different approach to try and reduce the reported variability in management of patients with hypertension by general practitioners.

Aged↗

Generation of T cells with lytic specificity for atypical antigens. I. A mitochondrial antigen in the rat.

F1 rats primed with normal parental strain lymphocyte populations and restimulated in culture with parental lymphoblasts generate potent cytotoxic T cell responses to unusual antigen systems. Here we describe in the Lewis (L)/DA anti-DA combination an antigen system most likely of mitochondrial origin with the following properties: it is transmitted maternally from DA strain females, inherited in an extra-chromosomal manner, restricted by class I RT1Aa major histocompatibility complex gene products, extinguished on target cells treated with chloramphenicol, and its pattern of expression in different rat strains correlates with restriction fragment-length polymorphisms of mitochondrial DNA. Sequence analysis of the rat ND1 gene indicates that the maternally transferred factor in the rat is not a homologue of the maternally transmitted factor responsible for the mitochondrial antigen in mice. In keeping with its inheritance from DA females, this antigen is present on target cells from (DA female x L male)F1 donors and all other F1 combinations derived from DA female parents, but absent from target cells from some F1 combinations (L/DA and Wistar-Furth [WF]/DA) derived from DA strain males. The presence of this antigen in other F1 combinations (Brown Norway [BN]/DA, August 2880 [AUG]/DA, and PVG/DA) indicates that this mitochondrial antigen system is shared by the DA, BN, and PVG strains, but not by the L and WF strains.

Amino Acid Sequence↗

Generation of T cells with lytic specificity for atypical antigens. II. A novel antigen system in the rat dependent on homozygous expression of major histocompatibility complex genes of the class I-like RT1C region.

Lymphocytes from parental strain DA rats can induce potent killer cell responses to atypical antigen systems in F1 Lewis (L)/DA and DA/L recipients. Here, we describe an antigen system, H, present on homozygous parental target cells, but not on F1 cells. This antigen system is unusual in several respects: it does not involve class I RT1A gene products usually used by killer cell responses in the rat, it maps to the major histocompatibility complex (MHC) class I-like RT1C region, and it requires homozygous expression of RT1Cav1 alleles. This may be another example, this time involving the RT1C region, of an MHC gene product antigenically altered by an MHC-linked trans-activating modifier gene.

Animals↗

Generation of T cells with lytic specificity for atypical antigens. III. Priming F1 animals with antigen-bearing cells also having reactivity for host alloantigens allows for potent lytic T cell responses.

Here, we explore the conditions required for generating two different highly potent F1 antiparental killer cell populations to unusual antigens in rats. The first, L/DA anti-DA, has lytic specificity for two antigen systems: MTA, a mitochondrial antigen expressed on DA and DA Lewis (L) target cells restricted by RT1A class I molecules; and H, an antigen that maps to the class I-like RT1C region and is present only on parental target cells from donors homozygous at the major histocompatibility complex. The second killer population is generated in the reciprocal DA/L anti-DA combination and has lytic specificity only for the H antigen system. We show that the killer cells are T cells, and that generation of these F1 cytotoxic T lymphocytes (CTL) requires an in vivo priming step in which it is essential that the inoculated parental cells bear the relevant target antigens and possess alloreactivity for F1 host antigens. The requirement for alloreactivity and antigen on the same priming cell population suggests that these potent lytic responses depend on a situation akin to a hapten-carrier effect that bypasses otherwise ineffective helper responses by the host to these unusual antigens. Restimulation of F1 lymphocytes in culture is also necessary, requiring the presence of antigen on irradiated lymphoblast stimulator cells, but alloreactivity to responder cell antigens is not necessary; normal, nonactivated lymph node cells are completely ineffective as stimulators. For effective lysis, the target cells need not possess the potential for alloreactivity to responder F1 CTL. We also demonstrate in a preliminary way additional antigen systems defined by killer populations raised with other F1 antiparental strain combinations.

Animals↗