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Biomedical subjects

G Johnson

Publications and source records attributed to G Johnson.

At least 235 records · Page 13Linked to original sources
PubMed1994

A prospective randomized comparison of defibrillation efficacy of truncated pulses and damped sine wave pulses in humans.

INTRODUCTION: Damped sine wave pulses have been used for nearly 50 years in transthoracic defibrillation systems. The purpose of this study was to determine whether damped sine wave pulses have a role in implantable defibrillators. METHODS AND RESULTS: In 21 survivors of cardiac arrest, we prospectively compared defibrillation efficacy of a standard truncated capacitor (RC) monophasic pulse with a damped sine wave inductor-capacitor (LRC) pulse using a right ventricular-left ventricular epicardial patch-patch electrode system. The RC pulse was a standard 65% tilt monophasic waveform generated from a 120 mu F capacitor. The LRC pulse was designed to simulate the waveform currently used in transthoracic defibrillators and was generated by passing the charge stored on a 40 mu F capacitor through a 37-mH inductor. Capacitor voltage, peak delivered voltage, peak delivered current, discharge pathway resistance, delivered energy, and stored energy were compared for the two waveforms at the defibrillation threshold. There was no difference in defibrillation efficacy for the two waveforms. Peak delivered voltage was similar at the defibrillation threshold: 313 +/- 101 V for the RC pulse and 342 +/- 119 V for the LRC pulse (P = 0.16). Similarly, no differences were found in defibrillation threshold peak delivered current: 8.6 +/- 2.5 (RC) versus 9.3 +/- 2.7 (LRC) amperes (A) (P = 0.20); discharge pathway resistance: 37 +/- 11 (RC) versus 38 +/- 13 (LRC) omega (P = 0.71); delivered energy: 7.0 +/- 4.5 (RC) versus 7.0 +/- 4.0 (LRC) joules (J) (P = 0.88); and stored energy: 8.7 +/- 5.7 (RC) versus 9.8 +/- 5.4 (LRC) J (P = 0.35). Although both waveforms performed the same, it was necessary to use substantially higher stored voltages with the damped sine wave delivery system than with the truncated waveform delivery system: 356 +/- 110 V for the RC pulse and 675 +/- 192 V for the LRC pulse (P < 0.0001). CONCLUSION: This study demonstrates that RC monophasic pulses provide equally effective epicardial defibrillation as LRC pulses with respect to delivered voltage and current and stored and delivered energy. However, in order for LRC pulses to provide comparable delivered voltage, current, and energy to that of RC pulses, nearly twice the voltage must be stored on the capacitor to accomplish the same task. These findings suggest that despite the nearly 50-year experience with damped sine wave pulses with transthoracic defibrillators, there is no need to begin using damped sine wave pulses for implantable defibrillators. Moreover, these data raise a question regarding the need for inductors in transthoracic defibrillators.

Aged↗
PubMed1994

The effect of audit and feedback on data recording in the accident and emergency department.

Thirteen newly appointed senior house officers (SHOs) at two hospitals were assessed in the recording of two variables: Glasgow Coma Scale (GCS) and diagnostic coding at Hospital A, and GCS at Hospital B. At Hospitals A and B baseline recordings of these variables were established. Active feedback (in the form of data presentation and discussion) was given at 6 and 11 weeks and a final 4-week audit was performed on GCS recordings at 20 weeks. Analysis of GCS recordings of head injuries at Hospitals A and B showed an increase from baseline values of 162/401 (40%) to 336/420 (80%) after feedback 1, and after feedback 2 recordings increased to 379/429 (88%). This was maintained in the last 4-week audit which showed recordings of 220/244 (90%). Further analysis of Hospital A's data showed the SHOs recorded diagnostic coding in 1335/4406 (30%) of cases. After feedback 1, recordings increased to 2550/3327 (77%). After feedback 2 there was no change in recording 2712/3530 (77%). Active feedback improves data recording. The first feedback has a greater impact than the second. Two feedbacks produce a sustained effect in 6 months.

Craniocerebral Trauma↗
PubMed1994

Assessment of an objective structured clinical examination (OSCE) for undergraduate students in accident and emergency medicine.

Conventional techniques for assessing the knowledge and clinical competence of undergraduate medical students are widely acknowledged as being unsatisfactory. We introduced an objective structured clinical examination (OSCE) for our fourth year medical students at the end of their accident and emergency (A&E) medicine attachment. This paper outlines the organisation of the examination and the results of a comparison of marks obtained from the OSCE, from a multiple choice type examination and from a subjective rating of the students performance by their teachers. We found the OSCE to be an acceptable form of examination to both medical students and examiners. Our results show significant correlation between marks obtained on the OSCE exam and subjective rating of the students ability. There was no statistically significant relationship to marks obtained on a multiple choice questionnaire exam. The OSCE format is particularly appropriate to A&E medicine where the participation of patients in traditional clinical examinations is impractical.

Clinical Competence↗
PubMed1994

Magnetic resonance imaging in degenerative ataxic disorders.

MRI of the brain was performed in 53 patients with a variety of degenerative ataxias and related disorders and 96 control subjects. Atrophy of intracranial structures was not seen in patients with the pure type of hereditary spastic paraplegia, or in early cases of Friedreich's ataxia. In advanced Friedreich's ataxia there was atrophy of the vermis and medulla. The MRI features of early onset cerebellar ataxia with retained reflexes were variable, and suggest heterogeneity. In autosomal dominant cerebellar ataxias, most patients had cerebellar and brainstem atrophy, probably reflecting the pathological process of olivopontocerebellar atrophy; there was no clearly defined group with both clinical and imaging features of isolated cerebellar involvement. The MRI abnormalities in idiopathic late onset cerebellar ataxia were predominantly those of cerebellar and brainstem atrophy or pure cerebellar atrophy. The clinical and imaging features of brainstem abnormalities were discordant in several patients. Pure cerebellar atrophy was associated with slower progression of disability. Cerebral atrophy was common in the late onset ataxias. Cerebral white matter lesions, although usually few in number, were observed in significantly more patients than controls, particularly those aged over 50 years.

Adolescent↗
PubMed1994

Caries incidence, salivary flow rate and efficacy of fluoride gel treatment in irradiated patients.

The caries-preventive effect of daily applications of a fluoride gel was studied in 55 patients receiving radiotherapy for tumors of the head and neck. The study was designed as a randomized, double-blind study with two parallel groups. From the start of radiotherapy one group received a 0.42% F gel once a day for 1 year. The other group received a daily application of a 1.23% F gel for 4 weeks followed by the use of the 0.42% F gel daily for 1 year. The results showed that in patients with an unstimulated saliva flow of > 0.1 ml/min daily fluoride gel treatment with a fluoride concentration of 0.42% F was sufficient to inhibit caries almost completely. The use of the 1.23% F gel was not superior to the 0.42% gel treatment program alone. In an attempt to evaluate the salivary flow rate as a diagnostic criterion for increased caries risk, sensitivity and specificity were evaluated. It was found that with an unstimulated saliva flow rate of < 0.1 ml/min the positive predictive value was 80%. The corresponding value for stimulated salivary flow rate of < 0.5 ml/min was 85%. One can therefore predict that 80% of patients with flow rates < 0.1 ml/min will develop at least one carious lesion per year. The corresponding negative predictive value for unstimulated saliva flow > 0.1 ml/min was 75%. That means that 75% of patients using the 0.42% F gel daily and with at least some saliva secretion will not develop any new carious lesions.

Dental Caries↗
PubMed1994

Prospective, randomized comparison in humans of a unipolar defibrillation system with that using an additional superior vena cava electrode.

BACKGROUND: A unipolar defibrillation system using a single right ventricular (RV) electrode and the active shell or "CAN" of the implantable cardioverter-defibrillator itself situated in a left infraclavicular pocket has been shown to be as efficient in defibrillation as an epicardial lead system. The purpose of this study was to determine whether defibrillation efficacy can be improved further by adding a superior vena cava (SVC) electrode to this already efficient defibrillation system. METHODS AND RESULTS: We prospectively and randomly compared the defibrillation efficacy of a simplified unipolar defibrillation system, RV-->CAN, with that of one incorporating a high SVC electrode, RV-->SVC + CAN, in 15 consecutive cardiac arrest survivors undergoing implantation of a presently available transvenous defibrillation system. The RV defibrillation electrode was a 5-cm coil located on a 10.5F lead used as the anode in both lead configurations examined. The active CAN was a 108-cm2 surface area shell of a titanium alloy pulse generator used as the cathode in both configurations and placed in a left infraclavicular pocket. The SVC electrode was a 6F 5-cm-long coil and was used as an additional cathode positioned at the junction of the SVC and the left innominate vein. The defibrillation pulse used was a 65% tilt, asymmetric biphasic waveform delivered from a 120-microF capacitor. The defibrillation threshold (DFT) stored energy, leading edge voltage, current, and pulsing resistance were measured for both lead systems. The single-lead unipolar system, RV-->CAN, resulted in a stored energy DFT of 7.4 +/- 5.2 J, and the three-electrode dual pathway system, RV-->SVC + CAN, resulted in a DFT of 6.0 +/- 3.4 J (P = .20). There was no difference in defibrillation efficacy with the more complicated three-electrode system over the unipolar system despite a decrease in pulsing resistance to 48.6 +/- 3.5 omega compared with 61.2 +/- 5.9 omega for the unipolar system (P < .0001) and a slight rise in delivered current to 6.3 +/- 1.8 A compared with 5.5 +/- 2.0 A for the unipolar system (P = .062). CONCLUSIONS: The unipolar single-lead transvenous defibrillation system provides defibrillation at energy levels comparable to that reported with present epicardial lead systems. Coupling of this lead system to a third SVC electrode increases system complexity but offers little defibrillation advantage despite a large decrease in pulsing resistance and a modest increase in delivered current.

Defibrillators, Implantable↗
PubMed1994

Efficacy of a single-lead unipolar transvenous defibrillator compared with a system employing an additional coronary sinus electrode. A prospective, randomized study.

BACKGROUND: Recent development of a prototype single-lead unipolar transvenous defibrillator offers the possibility of device implantation with the ease of a permanent pacemaker. Lowering defibrillation energy requirements would allow for a further reduction in defibrillator generator size and enhance the feasibility of pacemaker-like placement. However, if achieving a lower defibrillation energy requires placing additional intracardiac leads, the potential advantage of a smaller generator may be offset by the disadvantages of a more complex lead system. The purpose of this study was to compare defibrillation energy requirements of a single-lead unipolar defibrillator with a three-electrode system employing an additional lead in the coronary sinus. METHODS AND RESULTS: Testing of a single-lead unipolar biphasic pulse defibrillation system versus a three-electrode system with an additional coronary sinus lead was performed in prospective, randomized fashion in 15 patients with a history of ventricular tachycardia or fibrillation. Ventricular fibrillation was induced with alternating current, and defibrillation threshold was measured by a pulse given 10 seconds after arrhythmia induction. The mean defibrillation threshold stored energy and mean leading edge voltage did not significantly differ between the two systems (11.3 +/- 5.9 J versus 9.9 +/- 5.2 J and 418 +/- 118 V versus 390 +/- 112 V, respectively; P > .4). Using either defibrillation system, all patients were successfully defibrillated by < 24 J and over half of patients by < 10 J. CONCLUSIONS: A unipolar transvenous biphasic defibrillation system is an effective means of treating ventricular fibrillation. The added complexity of additional leads is not offset by any significant improvement in defibrillation efficacy or energy requirements. Given the simplicity and effectiveness of a single-lead system coupled with a small generator, placement of defibrillation systems may now approach the ease of pacemaker implantation.

Adult↗
PubMed1994

Growth of human cells on plasma polymers: putative role of amine and amide groups.

The attachment and growth of human endothelial cells and fibroblasts was studied on polymer surfaces fabricated by the polymerization of volatile amine and amide compounds in a low pressure gas plasma, and by the treatment of various surfaces in ammonia plasmas, which served to increase the nitrogen content of the surface layers. Infrared spectra showed the presence of amide groups, including those cases where the volatile compound ('monomer') did not contain oxygen. The performance of the surfaces in cell attachment correlated with the surface hydrophilicity and the nitrogen content, although for the latter a fair degree of scatter indicated that a more complex relationship applies. All these surfaces supported the attachment and growth of human cells. Generally, amide plasma polymers were best but the individual monomer and the plasma parameters also played a role. From comparisons of the various surfaces, it is suggested that the amide group is the main promoter of cell attachment in nitrogen-containing plasma surfaces.

Amides↗
PubMed1994

Roles of serum vitronectin and fibronectin in initial attachment of human vein endothelial cells and dermal fibroblasts on oxygen- and nitrogen-containing surfaces made by radiofrequency plasmas.

Fluoropolymers modified by plasma modification were studied for their suitability as surfaces for the adhesion of cells. We compared films made by plasma modification of fluoroethylenepropylene (FEP) using nitrogen-containing gases (ammonia or dimethyl acetamide) with films deposited using oxygen-containing monomers (methanol, methyl methacrylate or sequential treatment with toluene then water). The surfaces were compared for the attachment and spreading of human vein endothelial cells and human dermal fibroblasts. The initial attachment and spreading of cultured fibroblasts and endothelial cells onto films deposited using nitrogen-containing gases were equivalent to that onto films deposited using oxygen-containing monomers, but there were some differences in the mechanism of attachment. With films deposited using oxygen-containing monomers, the initial attachment and spreading of endothelial cells failed when the medium contained 15% (v/v) serum from which both fibronectin (Fn) and vitronectin (Vn) had been removed. Similarly, initial attachment and spreading of endothelial cells onto films deposited using oxygen-containing monomers were reduced by 62-86% when the cells were seeded in medium containing Vn-depleted serum (which contained Fn). Endothelial cells attached and spread onto films made using oxygen-containing monomers, when seeded in medium containing Fn-depleted serum (which contained Vn). On films deposited using nitrogen-containing gases, the adhesion of endothelial cells was only slightly reduced in Vn-depleted medium (as compared to attachment in medium containing unmodified serum). Furthermore, surfaces which had incorporated nitrogen were more effective than were oxygen-containing films in adsorbing sufficient serum Fn as to promote endothelial cell attachment. Similar results were seen for the attachment and spreading of fibroblasts as for the endothelial cells. For fibroblasts, attachment and spreading onto oxygen-containing films and onto nitrogen-containing films were not simply dependent upon either the Vn content or the Fn content of the medium. Maximal attachment and spreading of fibroblasts were, however, dependent upon adsorption of both serum Vn and Fn.

Blood Proteins↗
PubMed1994

A business case for health informatics standards.

The acceleration of health informatics standards development has both value to health care delivery as well as economic value to the nation's economy. This paper describes the business case for standards development to enable development and implementation of computer-based patient record systems.

Computer Communication Networks↗
PubMed1993

Heat-shocked neuronal PC12 cells reveal Alzheimer's disease--associated alterations in amyloid precursor protein and tau.

The Alzheimer's disease (AD) brain contains many abnormal protein modifications. These include the abnormal processing of amyloid precursor protein (APP) to form the amyloidogenic beta/A4 peptide and the abnormal phosphorylation of tau to form A68, the major constituent of the neurofibrillary tangle. In addition, many of the biochemical alterations found in the AD brain are also found in heat-shocked or stressed cells. We used heat-shocked neuronal PC12 cells to investigate the effects of stress on APP and tau. We found that by simply exposing neuronal PC12 cells to an elevated temperature (45 degrees C) for 30 minutes, they exhibited several features characteristic of the heat shock response. These included a 45% reduction in total protein synthesis, the induction of heat shock protein (hsp) 72, and increased phosphorylation of the protein synthesis initiation factor eIF-2 alpha. The heat-shocked cells also exhibited alterations in the metabolism and phosphorylation of APP. Under heat shock conditions, we found two additional APP-like polypeptides not present in controls and a significant decrease in the phosphorylation state of APP. We also found that an A68-like protein is formed in neuronal PC12 cells when subjected to elevated temperature. This A68-like protein was formed with heat shock even in the absence of protein synthesis, suggesting that its production occurred post-translationally. The tau/A68 polypeptides were identified as phosphoproteins, and the phosphorylation of tau to form A68 was reversed with recovery of the cells from heat shock. Immunoprecipitation of lysates from heat shocked cells with antibodies to hsp72/73 resulted in co-precipitation of tau, but not A68 with hsp72 indicating a stable complex formation between these two proteins. These results suggest that heat shock proteins may play either a protective or promoting role in the formation of A68 and/or the amyloidogenic C-terminal fragment of APP.

Alzheimer Disease↗
PubMed1993

Epstein-Barr virus-coded BHRF1 protein, a viral homologue of Bcl-2, protects human B cells from programmed cell death.

Epstein-Barr virus, a human herpesvirus that persists within the B-lymphoid system, can enhance the survival potential of latently infected B cells in vitro through up-regulation of the cellular survival protein Bcl-2. The possibility that an analogous effect is operative in lytically infected cells was suggested by the observation of distant sequence homology between an Epstein-Barr virus-coded early lytic cycle protein, BHRF1, and Bcl-2. Here we show by gene transfer that BHRF1 resembles Bcl-2 both in its subcellular localization and in its capacity to enhance B-cell survival. Thus confocal microscopic analysis of cells acutely cotransfected with BHRF1 and Bcl-2 expression vectors revealed substantial colocalization of the two proteins in the cytoplasm. In subsequent experiments, stable BHRF1 gene transfectants of Burkitt lymphoma cells paralleled Bcl-2 transfectants in their enhanced survival under conditions that induce cell death by apoptosis. Despite their limited sequence conservation, therefore, the two proteins appear to be functionally homologous. We suggest that BHRF1 provides an alternative, Bcl-2-independent, means of enhancing B-cell survival that may operate during the virus lytic cycle.

Animals↗