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Biomedical subjects

D Hunter

Publications and source records attributed to D Hunter.

At least 91 records · Page 5Linked to original sources

Activation of a novel calcium-dependent protein-tyrosine kinase. Correlation with c-Jun N-terminal kinase but not mitogen-activated protein kinase activation.

Many G protein-coupled receptors (e.g. that of angiotensin II) activate phospholipase Cbeta, initially increasing intracellular calcium and activating protein kinase C. In the WB and GN4 rat liver epithelial cell lines, agonist-induced calcium signals also stimulate tyrosine phosphorylation and subsequently increase the activity of c-Jun N-terminal kinase (JNK). We have now purified the major calcium-dependent tyrosine kinase (CADTK), and by peptide and nucleic acid sequencing identified it as a rat homologue of human PYK2. CADTK/PYK2 is most closely related to p125(FAK) and both enzymes are expressed in WB and GN4 cells. Angiotensin II, which only slightly increases p125(FAK) tyrosine phosphorylation in GN4 cells, substantially increased CADTK tyrosine autophosphorylation and kinase activity. Agonists for other G protein-coupled receptors (e.g. LPA), or those increasing intracellular calcium (thapsigargin), also stimulated CADTK. In comparing the two rat liver cell lines, GN4 cells exhibited approximately 5-fold greater angiotensin II- and thapsigargin-dependent CADTK activation than WB cells. Although maximal JNK activation by stress-dependent pathways (e.g. UV and anisomycin) was equivalent in the two cell lines, calcium-dependent JNK activation was 5-fold greater in GN4, correlating with CADTK activation. In contrast to JNK, the thapsigargin-dependent calcium signal did not activate mitogen-activated protein kinase and Ang II-dependent mitogen-activated protein kinase activation was not correlated with CADTK activation. Finally, while some stress-dependent activators of the JNK pathway (NaCl and sorbitol) stimulated CADTK, others (anisomycin, UV, and TNFalpha) did not. In summary, cells expressing CADTK/PYK2 appear to have two alternative JNK activation pathways: one stress-activated and the other calcium-dependent.

Amino Acid Sequence↗

New directions for health: towards a knowledge base for public health action.

The need for new types of solutions to respond to community health needs, along with the poor fit between research and the knowledge needed for improving the health of populations, have stimulated a renewal process in the field of public health. Growing out of this movement, an international workshop held at the Nuffield Institute for Health, University of Leeds in 1993 took up issues related to the role and limitations of epidemiology as generally practiced today. Concern for creating a relevant and sound knowledge base for public health action was the impetus guiding this project. Some of the major topics taken up in the deliberations of the workshop are reflected in the selection of papers that follow. They are highlighted and supplemented with an overview of other issues taken up by the conferees in this introduction.

Artificial Intelligence↗

Ultrasonographically adjusted midtrimester risk of trisomy 21 and significant chromosomal defects in advanced maternal age.

OBJECTIVE: Our purpose was to determine whether normal midtrimester ultrasonography results reduces the risk of fetal Down syndrome and any clinically significant chromosomal defects in pregnancies with advanced maternal age and to develop risk tables on the basis of age and ultrasonographic results. STUDY DESIGN: Biometry data were obtained in 4079 women between 15 and 24 weeks undergoing amniocentesis for maternal age. Expected values of humerus, femur, both combined, and abdominal circumference based on biparietal diameter were generated from a normal group. Observed/expected values of each parameter and nuchal thickness > or = 6 mm was used to screen for Down syndrome and any clinically significant chromosome defects. Receiver-operator characteristic curves were used to determine threshold screening values for each parameter. By use of stepwise logistic regression the optimal measurements for detection of chromosome anomalies were established. An abnormal ultrasonography result was defined as either abnormal biometry choroid plexus cysts or a structural defect. RESULTS: The finding of shortened humerus (observed/expected < 0.90), abnormal nuchal thickness, or an anatomic defect had the highest sensitivity for Down syndrome detection, 70.6%, p < 0.0001, whereas a short humerus, small abdominal circumference, (observed/expected < 0.92), or an anatomic defect had a sensitivity of 46.7%, p < 0.0001, for any significant chromosome defect. With a normal ultrasonography the risk of Down syndrome in a 39-year-old woman falls from 1:100 to < 1:292. CONCLUSION: A normal ultrasonography substantially reduces the risk of Down syndrome and any chromosome abnormality. This information is useful in counseling women who decline amniocentesis on the basis of maternal age.

Biometry↗

Risk of Down syndrome and any clinically significant chromosome defect in pregnancies with abnormal triple-screen and normal targeted ultrasonographic results.

OBJECTIVE: Our purpose was to study prospectively the use of ultrasonographic biometry to refine the risk estimates for both Down syndrome and any clinically significant chromosome defect in women with abnormal biochemical triple-screen results. STUDY DESIGN: Ultrasonographic biometry and anatomic survey were performed on study and control cases. Expected values for humerus, femur, combined humerus plus femur lengths, and abdominal circumference were generated on the basis of biparietal diameter obtained from a normal group. Threshold observed/expected values of each measurement for screening for Down syndrome and clinically significant chromosome defects were determined with receiver-operator characteristic curves. By stepwise logistic regression analysis the optimal screening parameters, including nuchal thickness, for detection of Down syndrome and clinically significant chromosome defect were determined. Risk tables for chromosome anomalies were developed on the basis of ultrasonography and triple-screen values. RESULTS: Of 1034 cases at risk for Down syndrome (risk > or = 1/270) or trisomy 18 on the basis of triple-screen results, there were 11 cases of Down syndrome, 1 of trisomy 18, and 17 clinically significant chromosome defects. Abnormal nuchal thickness or observed/expected humerus length < 0.92 was the most sensitive parameter for Down syndrome detection. Abnormal nuchal thickness or observed/expected combined femur and humerus length < 0.90 was the most sensitive for significant chromosome defects. With abnormal biometry or anatomy the Down syndrome risk was 8 of 127 versus 1 of 753 in normals, odds ratio 50.4 (95% confidence interval 6.4 to 90.2), p < 0.00001, and the risk of significant defects was 11 of 90 versus 6 of 830 in normals, odds ratio 19.3 (95% confidence interval 6.4 to 60.5), p < 0.00001. In a pregnancy with a 1 in 270 triple-screen risk for Down syndrome, normal biometric and anatomic results reduce the risk to 1 in 2100. CONCLUSION: Normal ultrasonographic anatomy and biometry significantly reduces the risk of both Down syndrome and any significant chromosome defects in pregnancies with abnormal triple-screen results.

Biochemistry↗

X-ray microanalysis of cell elements in normal and cystic fibrosis jejunum: evidence for chloride secretion in villi.

BACKGROUND & AIMS: Cystic fibrosis transmembrane conductance regulator (CFTR) is an adenosine 3',5'-cyclic monophosphate-dependent chloride channel that is defective in cystic fibrosis. The aims of this study were to determine if defective apical chloride secretion in the intestine of patients with cystic fibrosis alters the intracellular electrolyte milieu and to examine the geographical localization of CFTR in the normal intestine. METHODS: The content of intracellular elements was assessed in cryosections using energy-dispersive x-ray microanalysis, and CFTR was identified by immunocytochemistry using commercially available antibodies. RESULTS: Cystic fibrosis jejunum had a significantly lower Na+ content, higher K+ and Cl- content, and higher potassium/phosphorus ratio in both villus and crypt regions. Incubation of normal jejunum with the phosphodiesterase inhibitor 3-isobutyl-1-methyl-xanthine (300 mumol/L) resulted in decreased K+ and Cl- content in both crypt and villus regions, indicative of Cl- secretion. CFTR was identified on the surface of normal villus and crypt enterocytes but not in cystic fibrosis samples. CONCLUSIONS: Defective apical chloride channels in cystic fibrosis result in alterations in the intracellular electrolyte milieu. The microanalysis observations and immunocytochemical studies imply a role for villus enterocytes in human intestinal chloride secretion.

1-Methyl-3-isobutylxanthine↗

Health Management Guide. Disease management.

Disease management has been described as a comprehensive, integrated approach to care and reimbursement based on the natural course of a disease. It requires a management approach which brings together research evidence, best practice and inter-professional and inter-agency working. Starting with the ideal of continuity of care for individual patients, it implies structured co-ordination of care over time and across primary, secondary and tertiary settings. The appeal of disease management is that it promises reduced costs, combined with increased quality of care and patient satisfaction. But the concept is open to different definitions and interpretations and its effectiveness in improving UK healthcare is still largely untested. This Health Management Guide removes the mystique behind disease management and puts it in the context of existing knowledge and practice. Treating it as a concept, rather than a specific technique, it distinguishes between its different potential applications, offers practical guidance on implementation, and reports on how NHS organisations are taking it forward.

Asthma↗

Consensus methods for medical and health services research.

Health providers face the problem of trying to make decisions in situations where there is insufficient information and also where there is an overload of (often contradictory) information. Statistical methods such as meta-analysis have been developed to summarise and to resolve inconsistencies in study findings--where information is available in an appropriate form. Consensus methods provide another means of synthesising information, but are liable to use a wider range of information than is common in statistical methods, and where published information is inadequate or non-existent these methods provide a means of harnessing the insights of appropriate experts to enable decisions to be made. Two consensus methods commonly adopted in medical, nursing, and health services research--the Delphi process and the nominal group technique (also known as the expert panel)--are described, together with the most appropriate situations for using them; an outline of the process involved in undertaking a study using each method is supplemented by illustrations of the authors' work. Key methodological issues in using the methods are discussed, along with the distinct contribution of consensus methods as aids to decision making, both in clinical practice and in health service development.

Consensus Statements as Topic↗

Another false dawn.

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Competitive Medical Plans↗

Life-threatening alterations in heart rate after the use of adenosine in atrial flutter.

Adenosine has become the preferred treatment for common types of supraventricular tachycardia because it is extremely effective and rarely associated with with serious side effects. It has also been advocated as an intervention for diagnostic use to assess uncommon types of tachycardia. Evidence is shown in this report that adenosine was associated with dangerous worsening of arrhythmia in patients with atrial flutter. In two patients, adenosine precipitated acceleration of ventricular response, in one case necessitating emergent cardioversion. Both patients had atrial flutter with 2 to 1 atrioventricular block that evolved into 1 to 1 atrioventricular conduction. In three other patients, adenosine was associated with prolonged bradyasystole and hypotension. In each of the five patients, adenosine was given in a standard fashion (6 or 12 mg). In summary, adenosine should be recognized as a potentially dangerous intervention in patients with atrial flutter. If it is used for diagnostic purposes, resuscitative equipment should be readily available.

Adenosine↗

Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery.

STUDY OBJECTIVE: To investigate the efficacy, opioid-sparing effects and any reduction in adverse events of a continuous intravenous (i.v.) infusion of ketorolac following lower abdominal surgery. DESIGN: Randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Inpatient elective gynecologic surgical patients. PATIENTS: 60 ASA physical status I or II patients aged 18 to 70 years scheduled for elective abdominal hysterectomy. INTERVENTIONS: Following standardized preparation and anesthesia, continuous i.v. infusions of either ketorolac or placebo were administered for 24 hours postoperatively with a patients' standardized postoperative protocol. Supplementary analgesia was administered by an i.v. patient-controlled analgesia (PCA) system. MEASUREMENTS AND MAIN RESULTS: A significantly lower proportion of the patients in the ketorolac group (6%) rated their pain at 24 hours as moderate or severe compared with patients in the placebo group (34%) (p = 0.04). Mean 24-hour morphine consumption was significantly lower in the ketorolac group (43 mg; SEM 5 mg) compared with the placebo group (55 mg SEM 5 mg) (p = 0.02). There was no significant difference in the incidence of postoperative hypoxemia between the groups with respect to mean times per hour spent with oxygen saturation (SPO2) less than 85%, more than 85% but less than 90%, or more than 90% but less than 94%, mean hourly SPO2, or the incidence and duration of severe hypoxemic episodes. Nausea and vomiting were the only significant adverse events, and they occurred in 30% of patients in both groups. CONCLUSION: Intravenous infusion of ketorolac combined with morphine delivered via a PCA device would appear to be a valuable method of providing balanced analgesia following lower abdominal surgery.

Adolescent↗

Childhood socioeconomic status and risk of cardiovascular disease in middle aged US women: a prospective study.

OBJECTIVE: To examine prospectively the relationship of childhood socioeconomic status and risk of cardiovascular disease in middle aged women. DESIGN: A prospective cohort of women with 14 years follow up data (1976-90). SUBJECTS: A total of 117,006 registered female nurses aged 30 to 55 years in 1976 and free of diagnosed coronary heart disease, stroke, and cancer at baseline. MAIN OUTCOME MEASURES: Incident fatal coronary heart disease, non-fatal myocardial infarction, and stroke (fatal and non-fatal). RESULTS: Low socioeconomic status in childhood was associated with a modestly increased risk of incident non-fatal myocardial infarction and total cardiovascular disease in adulthood. Compared with middle aged women from white collar childhood backgrounds, the age adjusted risk of total cardiovascular disease for women from blue collar backgrounds was 1.13 (95% CI 1.02, 1.24) and that of non-fatal myocardial infarction was 1.23 (95% CI 1.06, 1.42). No significant increase in risk was observed for stroke or fatal coronary heart disease. Adjustment for differences in family and personal past medical history, medication use, exercise, alcohol intake, diet, birth weight, being breastfed in infancy, and adult socioeconomic circumstance somewhat attenuated the increased risks observed for women from blue collar childhood socioeconomic backgrounds. In multivariate analysis, women whose fathers had been manual labourers had the highest relative risk of total coronary heart disease (RR = 1.53; 95% CI 1.09, 2.16) and non-fatal myocardial infarction (RR = 1.67; 95% CI 1.11, 2.53) when compared with women whose fathers had been employed in the professions. CONCLUSION: In this group lower childhood socioeconomic status was associated with a small but significant increase in the risk of total coronary heart disease as well as non-fatal myocardial infarction. For women from the most socioeconomically disadvantaged childhood backgrounds, the association is not explained by differences in a large number of cardiovascular risk factors, by differences in adult socioeconomic status, or by differences in indices of nutrition during gestation or infancy.

Adult↗

Mortality league tables: do they inform or mislead?

OBJECTIVE: To examine certain methodological issues related to the publication of mortality league tables, with particular reference to severity adjustment and sample size. DESIGN: Retrospective analysis of inpatient hospital records. SETTING: 22 hospitals in North West Thames health region for the fiscal year 1992-3. SUBJECTS: All admissions with a principal diagnosis of aortic aneurysm, carcinoma of the colon, cervical cancer, cholecystectomy, fractured neck of femur, head injury, ischaemic heart disease, and peptic ulcer. MAIN MEASURES: In hospital mortality rates adjusted by disease severity and calculated on the basis of both admissions and episodes. RESULTS: The numbers of deaths from specific conditions were often small and the corresponding confidence intervals wide. Rankings of hospitals by death rate are sensitive to adjustment for severity of disease. There are some differences that cannot be explained using routine data. CONCLUSIONS: Comparison of crude death rates may be misleading. Some adjustment for differences in severity is possible, but current systems are unsatisfactory. Differences in death rates should be studied, but because of the scope for manipulating data, this should be undertaken in a collaborative rather than a confrontational way. Any decision to publish league tables of death rates will be on political rather than scientific grounds.

Adolescent↗

Increasing incidence of anorexia nervosa in the female population of northeast Scotland.

OBJECTIVE: The aim of the study was to determine whether there has been an increase in the incidence of anorexia nervosa in the female population in the northeast of Scotland since the 1960s. METHOD: Standardized diagnostic criteria were applied to the case records of female subjects who had been diagnosed as suffering from anorexia nervosa and had presented for the first time to psychiatric services between 1965 and 1991 or had been admitted for the first time to a general hospital between 1970 and 1991. Age-standardized annual incidence rates were calculated from 1965 through 1991. As a broad measure of severity, the weights of patients in 3 early years of the study, 1970-1972, were compared with those of patients in the last 3 years, 1989-1991. RESULTS: Over the 27-year period studied, 287 patients received confirmed diagnoses of anorexia nervosa, and the mean annual increase in incidence was 5.3%. The rate of increase was highly statistically significant. Comparison of weights at presentation showed a trend for patients presenting in 1970-1972 to be lighter than those presenting in 1989-1991. CONCLUSIONS: Rates of referral for female subjects with anorexia nervosa have greatly increased since the 1960s. These rates likely reflect a genuine increase in incidence, but the data suggest that less severely ill patients are now being referred.

Adolescent↗

Gender-specific changes since 1900 in the season-of-birth effect in schizophrenia.

BACKGROUND: It was hypothesised that the size of the season-of-birth effect may have decreased in tandem with the apparent decline in the incidence of schizophrenia. METHOD: Through the Aberdeen Psychiatric Case Register, subjects were identified who had been diagnosed as schizophrenic and had been born between 1900 and 1969. The ratio of winter/spring to summer/autumn births was compared across the seven decades for both sexes together, for men, and for women. RESULTS: For the 1935 men, but not for the 1620 women, there was a highly significant increase (P = 0.0009) in season-of-birth effect. CONCLUSION: Non-seasonal factors have contributed to a declining incidence of schizophrenia in both sexes. 'Seasonal' factors to which female foetuses are more susceptible than male foetuses (such as infection or malnutrition) have also decreased in frequency, severity, or both, but this has not happened with factors affecting males, leading to an increase of their season-of-birth effect.

Age Factors↗

Energy expenditure of below-knee amputees during harness-supported treadmill ambulation.

Traditional rehabilitation of amputees is primarily aimed at strengthening remaining musculature necessary for prosthetic use and gait training. Available gait training time, however, is often limited by pain, residual limb skin tolerance, and the patient's cardiovascular endurance. Harness-supported treadmill ambulation is a rehabilitation technique being used by physical therapists to decrease an individual's body weight by a given percentage during exercise. This, theoretically, allows an amputee to ambulate on a prosthesis at a lower energy cost. The purpose of this study was to compare the energy expenditure of healthy below-knee amputee volunteers with healthy able-bodied volunteers during harness-supported treadmill ambulation in order to determine if energy conservation is achieved. Subjects were tested on a treadmill, walking at .67 m/sec (1.5 mph) and 1.34 m/sec (3.0 mph) during each of the following randomized harness-supported treadmill ambulation situations: full body weight, 20% body weight supported, and 40% body weight supported. During the last minute of each trial, rate of perceived exertion, heart rate, and standardized indirect calorimetry oxygen consumption (VO2, ml/kg/min) measures were collected. Caloric expenditure (kl/min) was calculated using metabolic conversion equations. Peak heart rate, peak VO2, and peak kl/min were measured after the conclusion of the last walking trial by taking each subject to volitional fatigue. Data were analyzed for each harness-supported treadmill ambulation situation and group using analysis of variance (ANOVA). The researchers identified significantly lower ratings of perceived exertion, heart rates, and VO2s for able-bodied subjects vs. below-knee amputees for all trials. Both groups demonstrated significantly lower heart rates, VO2s, and kl/min at 1.34 m/sec with 40% body weight supported.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Free vascularized temporal parietal flap in hand surgery.

Free vascularized temporo-parietal fascia (TPF) flap is a flap of thin, pliable and vascularized tissue which can cover an area measuring up to 12 cm x 14 cm. The flap is harvested based on temporal vessels, which provide a smooth, gliding surface for tendon function and eliminates the need for secondary procedures usually required by the pedicled or bulky free vascularized myocutaneous flaps. The donor pedicle is long and consistent with an average diameter of 3 mm in adults. This flap is versatile. In 12 resurfacings for traumatic wounds of hand and wrist, no flaps were lost. Donor site morbidity, except for a transient sideburn hair loss in one case, was not encountered. We recommend this flap as a viable one-stage procedure for coverage of complex hand wounds.

Adolescent↗