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Biomedical subjects

D James

Publications and source records attributed to D James.

At least 91 records · Page 5Linked to original sources
PubMed1997

Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial.

CONTEXT: Interest in home-visitation services as a way of improving maternal and child outcomes has grown out of the favorable results of a trial in semirural New York. The findings have not been replicated in other populations. OBJECTIVE: To test the effect of prenatal and infancy home visits by nurses on pregnancy-induced hypertension, preterm delivery, and low birth weight; on children's injuries, immunizations, mental development, and behavioral problems; and on maternal life course. DESIGN: Randomized controlled trial. SETTING: Public system of obstetric care in Memphis, Tenn. PARTICIPANTS: A total of 1139 primarily African-American women at less than 29 weeks' gestation, with no previous live births, and with at least 2 sociodemographic risk characteristics (unmarried, <12 years of education, unemployed). INTERVENTION: Nurses made an average of 7 (range, 0-18) home visits during pregnancy and 26 (range, 0-71) visits from birth to the children's second birthdays. MAIN OUTCOME MEASURES: Pregnancy-induced hypertension, preterm delivery, low birth weight, children's injuries, ingestions, and immunizations abstracted from medical records; mothers' reports of children's behavioral problems; tests of children's mental development; mothers' reports of subsequent pregnancy, educational achievement, and labor-force participation; and use of welfare derived from state records. MAIN RESULTS: In contrast to counterparts assigned to the comparison condition, fewer women visited by nurses during pregnancy had pregnancy-induced hypertension (13% vs 20%; P=.009). During the first 2 years after delivery, women visited by nurses during pregnancy and the first 2 years of the child's life had fewer health care encounters for children in which injuries or ingestions were detected (0.43 vs 0.55; P=.05); days that children were hospitalized with injuries or ingestions (0.03 vs 0.16; P<.001); and second pregnancies (36% vs 47%; P=.006). There were no program effects on preterm delivery or low birth weight; children's immunization rates, mental development, or behavioral problems; or mothers' education and employment. CONCLUSION: This program of home visitation by nurses can reduce pregnancy-induced hypertension, childhood injuries, and subsequent pregnancies among low-income women with no previous live births.

Child Development↗
PubMed1997

Resistance to methicillin and other antibiotics in isolates of Staphylococcus aureus from blood and cerebrospinal fluid, England and Wales, 1989-95.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) strains are colonising hospital patients in most areas of England and Wales, UK. The extent to which they cause invasive infection can be gauged from their presence in isolates from blood or cerebrospinal fluid. METHODS: About 200 clinical laboratories reported the results of susceptibility testing of between 4501 and 6370 isolates of S aureus from blood or cerebrospinal fluid in each of the years 1989-95. We assessed the rate of resistance to methicillin and other antibiotics for each of these years. FINDINGS: Resistance to methicillin was stable at about 1.5% of isolates during 1989-91, but increased thereafter to 13.2% in 1995 (p < 0.001). At the same time there was a significant increase in the percentage of isolates resistant to erythromycin, clindamycin, ciprofloxacin, gentamicin, trimethoprim, and rifampicin (p < 0.001 for each)-resistance characteristics often seen in MRSA. Resistance to benzylpenicillin increased slightly but significantly (p < 0.001); resistance to fusidic acid was stable (p > 0.05); resistance to tetracycline decreased significantly (p < 0.001). INTERPRETATION: Among cases of S aureus bacteraemia, the proportion due to MRSA has increased significantly. Bacteraemia due to MRSA has a poor prognosis, especially if not treated with suitable antibiotics. Therefore, these findings are important, especially for management of patients and the development of antibiotic policies.

Anti-Bacterial Agents↗
PubMed1997

Antioxidant deficiency following clam enterocystoplasty.

OBJECTIVE: To assess whether there is a reduction in serum antioxidant activity in patients who have undergone a clam enterocystoplasty procedure. PATIENTS AND METHODS: Serum glutathione peroxidase (GPase) activity was measured in 20 patients who had undergone clam enterocystoplasty. Serum selenium concentration was also measured in 62 similar patients and compared with 56 healthy controls and 44 patients with a neuropathic bladder, mainly patients with spinal cord injuries who had not undergone surgery. RESULTS: GPase activity correlated well with serum selenium measurement. There was a significant reduction (P < 0.001) in serum selenium level in young (< 50 years old) non-neuropathic bladder patients following clam enterocystoplasty. This reduction in serum selenium was similar to that found in both unoperated patients with a neuropathic bladder (who are known to have an increased risk of developing bladder cancer) and those patients with a neuropathic bladder who had undergone augmentation. This reduction was not related to urinary tract infection nor the time since surgery. CONCLUSION: A reduction in serum selenium has been shown to increase susceptibility to bladder cancer following carcinogenic exposure to compounds such as nitrosamines. This study suggests that patients with idiopathic and congenital instability may be at an equally high risk as a result of undergoing this procedure.

Adolescent↗
PubMed1997

Mandibular reconstruction in children with obstructive sleep apnea due to micrognathia.

Obstructive sleep apnea in children with micrognathia may be severe enough to necessitate permanent airway maintenance. Affected children form a small, but important, group of patients because early reconstructive surgery to the mandible may permit decannulation. A policy of early and aggressive surgical management has been pursued for the past 15 years, and an audit of outcome was undertaken to confirm whether or not this policy has been justified. The records of 25 patients so treated between 1980 and 1994 were analyzed by an independent clinician. Decannulation was achieved in 20 of the children (80 percent). The conditions that were most amenable to successful treatment (100 percent) were hemifacial microsomia, temporomandibular ankylosis, and the Pierre Robin sequence. The outcome for children with Treacher Collins syndrome and Nager syndrome was less successful (75 and 60 percent, respectively). The worst outcome occurred in a mixed group of three children with other syndromes, two of whom failed decannulation. Surgery was most successful when carried out before the age of 2 years (87 percent) and after the age of 4 years (90 percent).

Adolescent↗
PubMed1997

Randomised trial of expectant versus surgical management of spontaneous miscarriage.

Thirty-five women with retained products of conception after spontaneous miscarriage were randomised to expectant (n = 19) or surgical (n = 16) management, respectively. Women were reviewed at one week, two weeks and six months. There were no significant differences in the number of days of pain, bleeding, sick leave or return to normal periods. Nine of twelve women from the expectant group and six of nine from the surgical group who attempted to conceive did so by six months. All 16 women were satisfied with conservative management. This study provides further reassurance when considering expectant management for spontaneous miscarriage both in the short and medium term.

Abortion, Incomplete↗
PubMed1996

Molecular interaction between limb deformity proteins (formins) and Src family kinases.

Ld proteins (formins) are encoded by the limb deformity (ld) gene and define a family of related gene products regulating establishment of embryonic polarity. In this study we establish that chicken and murine Ld proteins interact directly with Src family kinases (c-Src and c-Fyn). Specific binding is mediated by the proline-rich domain present in Ld proteins and the ligand binding surface of the Src SH3 domain. Co-immunoprecipitation of Ld and c-Src proteins from transfected cells shows that these proteins associate in vivo. Immunolocalization and biochemical fractionation of fibroblasts confirms the predominant nuclear localization of Ld proteins, but unexpectedly identifies a population of Ld proteins associated to cellular membranes. This population of Ld proteins co-localizes with membrane-associated c-Src proteins at both plasma and perinuclear membranes. These studies indicate that the morphoregulatory Ld proteins interact with signal transduction cascades by association to membrane-bound Src family kinases.

Amino Acid Sequence↗
PubMed1996

Distinguishing cerebrospinal fluid from saline used to identify the extradural space.

Because of the potential seriousness of unrecognized dural puncture during the performance of extradural analgesia and the widespread use of normal saline for the "loss of resistance" technique, it is important to differentiate between cerebrospinal fluid (CSF) and saline dripping from the extradural needle. During insertion of lumbar drains in 10 neurosurgical patients, we first identified the extradural space using saline for loss of resistance. Temperature (using the back of the gloved hand), pH, glucose and protein (using urine testing sticks) were tested by a blinded observer for ability to distinguish saline aspirated from the extradural space from CSF aspirated on establishing the dural puncture. Temperature, glucose and protein were independently 100% accurate in distinguishing saline from CSF. One saline sample had a pH value greater than 7 compared with nine CSF samples. We conclude that simple bedside testing for temperature, glucose, protein and pH accurately distinguished between CSF and saline used to identify the extradural space.

Adult↗
PubMed1996

Selenium deficiency and miscarriage: a possible link?

OBJECTIVE: To investigate a possible relationship between a deficiency in serum selenium concentration and first trimester miscarriage. DESIGN: An observational study. SETTING: A teaching hospital in South Wales. PARTICIPANTS AND METHODS: Serum selenium, albumin and total protein concentration were measured in 40 women admitted with first trimester nonrecurrent miscarriage. The results were compared with an equal number of age-matched nonpregnant healthy volunteers, and also from 40 pregnant women attending the antenatal clinic for booking in the first trimester. RESULTS: A reduction in serum selenium normally occurs in the first trimester of pregnancies that progress to term. However, a further statistically highly significant decrease in serum selenium was observed in those women who miscarried. CONCLUSION: Further studies are required to assess the potential benefits of selenium supplements.

Abortion, Spontaneous↗
PubMed1995

Limb deformity proteins during avian neurulation and sense organ development.

The nuclear Limb deformity (Ld) proteins (formins) are expressed during the avian primitive streak stages. Initially, they are detected predominantly in cells of the forming notochord, scattered mesodermal precursors and the induced neural plate. No expression is detected in endodermal cells. The subsequent graded distribution of Ld positive cells along the anterior-posterior axis of the neural tube follows the antero-posterior progression of its differentiation. The Ld proteins are also differentially expressed during induction and development of both the inner ear and eye. An unequal distribution of Ld proteins along the dorso-ventral axis of the otic vesicle is observed during its initial patterning. In the eye, the Ld proteins are expressed by the optic vesicle during secondary induction of the lens placode. Following induction, the proteins are also expressed by the newly formed lens placode, a process which is reminiscent of homeogenetic induction. During differentiation of the retina and lens, the Ld domains seem to demarcate territories, giving rise to specific eye structures. A comparative analysis of the Ld distribution and BrdU incorporation in the two sense organs indicates that the proteins are predominantly expressed by committed and/or differentiating (post-mitotic) cells. In general, expression of Ld proteins is induced during determination and remains during differentiation of particular cell-types. This study implies that the nuclear Ld proteins are involved in morphogenesis of both neuro-ectodermal and mesodermal structures.

Animals↗
PubMed1995

Fetal behaviour and the sudden infant death syndrome (SIDS).

To examine whether differences in sleep maturation could be identified before birth, behavioural studies were carried out in 28 fetuses. Studies were possible in all 28 fetuses at 28 weeks, but only in 26 fetuses at 36 weeks (two fetuses delivered before 36 weeks). The risk of sudden infant death syndrome (SIDS) was determined using the Oxford SIDS scoring system. The fetuses at greater risk of SIDS had coincidence of behavioural characteristics for a significantly lower percentage of the time than those at low risk. This difference reached significance (p < or = 0.05) only at 36 weeks.

Female↗
PubMed1995

Final height and long-term outcome after growth hormone therapy in Turner syndrome: results of a German multicentre trial.

Final height was investigated in 85 patients from a German multicentre trial of human growth hormone (GH) therapy in Turner syndrome. Six patients (mean age, 15.4 +/- 1.0 years; mean duration of therapy, 4.4 +/- 1.0 years) fulfilled the criteria for having reached final height (i.e. a height velocity < 0.5 cm/year). Four subjects had stopped therapy and two were still receiving GH. The mean final height of patients was 150.9 +/- 4.7 cm (range, 143.3-154.9 cm). In 3 subjects, projected final height was exceeded by 1.4, 6.5 and 10.8 cm, 1 patient just failed to reach projected final height by -1.7 cm and the 2 remaining patients did not attain projected final height by -3.2 and -12.1 cm. In the latter case, lack of height gain was associated with early onset and rapid progress of spontaneous puberty. The changes in height SDS were analysed in the other patients still receiving GH therapy over a period of 6 years, and it appeared that 2 IU/m2/day was less effective than 3 or 4 IU/m2/day, but that 4 IU/m2/day was no more effective than 3 IU/m2/day. These limited, non-controlled results indicate that GH therapy may be effective in increasing final height in Turner syndrome, though some patients may not benefit.

Adolescent↗