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Biomedical subjects

J Adam

Publications and source records attributed to J Adam.

At least 19 recordsLinked to original sources
PubMed2002

Symptom response after palliative radiotherapy for patients with brain metastases.

Whole brain radiotherapy (RT) is frequently used to palliate symptoms in patients with brain metastases, but the palliative benefit to patients has not been well documented. We conducted a longitudinal observational prospective study of patients receiving standard RT (20 Gray (Gy)/5 fractions) for symptomatic brain metastases. End-points were observer rating of neurological symptoms, patient-rated symptoms, performance status, neurological functional status, cognitive function and quality of life (QOL). Median survival for the 75 patients was 86 days (95% confidence interval (CI): 65-101 days). At 1 month, 19% of patients showed an improvement or resolution of presenting symptoms, 23% were stable and 55% had progressed or died. Patient-rated symptoms were increased at 1 month in comparison to baseline data. Only 4 patients had an improved performance status and 22 were stable. Many patients with brain metastases have a short life expectancy and may not benefit from even short duration radiation schedules. Further effort is needed to optimise patient selection and tailor treatment appropriately.

Adult↗
PubMed2001

Changing time in an operating suite.

This study focussed on time as a key resource within a hospital setting. The introduction of casemix-based funding, which changed the ways funds were obtained and distributed within the hospital, was accompanied by large cuts in the funds available to the hospital system. From the introduction of casemix-based funding to the conclusion of this study there was an increase of 20% in the number of cases through the operating suite. The increase was achieved, with a reduced budget, by intensifying work and increasing flexibility in the use of time. This approach to changing the use of time imposed considerable real 'costs' on staff, especially nurses, and created concerns about safety.

Attitude of Health Personnel↗
PubMed2001

Radiotherapy for brain metastases: defining palliative response.

BACKGROUND AND PURPOSE: Most patients with brain metastases are treated with palliative whole brain radiotherapy (WBRT). There is no established definition of palliative response. The aim of this study was to develop and test clinically useful criteria for response following palliative WBRT. MATERIALS AND METHODS: A prospective study was conducted of patients with symptomatic brain metastases treated with WBRT (20 Gy/5 fractions) and standardised steroid tapering. Assessments included observer rating of neurological symptoms, patient-completed symptom checklist and performance status (PS). Response criteria were operationally defined based on a combination of neurological symptoms, PS and steroid dose. RESULTS: Seventy-five patients were accrued. At 1 month, presenting neurological symptoms were improved in 14 patients, stable in 17, and worse in 21; 23 patients were not assessed, mainly due to death or frailty. Using response criteria defined a priori, 15% (95% CI 7-23%) of patients were classified as having a response to RT, 25% no response, and 29% progression; 27% were deceased at or soon after 1 month. A revised set of criteria was tested, with less emphasis on complete tapering of steroids: they increased the proportion of patients responding to 39% (95% CI 27-50%) but didn't change the large proportion who did not benefit (44%). CONCLUSIONS: Clinical response to RT of patients with brain metastases is multifactorial, comprising symptoms, PS and other factors. Assessment of degree of palliation depend on the exact definition used. More research is needed in this important area, to help validate criteria for assessing palliation after WBRT.

Adult↗
PubMed2000

Phosphatidylserine-dependent adhesion of T cells to endothelial cells.

Phosphatidylserine (PS) was exposed at the surface of human umbilical vein endothelial cells (HUVECs) and cultured cell lines by agonists that increase cytosolic Ca(2+), and factors governing the adhesion of T cells to the treated cells were investigated. Thrombin, ionophore A23187 and the Ca(2+)-ATPase inhibitor 2, 5-di-tert-butyl-1,4-benzohydroquinone each induced a PS-dependent adhesion of Jurkat T cells. A23187, which was the most effective agonist in releasing PS-bearing microvesicles, was the least effective in inducing the PS-dependent adhesion of Jurkat cells. Treatment of ECV304 and EA.hy926 cells with EGTA, followed by a return to normal medium, resulted in an influx of Ca(2+) and an increase in adhering Jurkat cells. Oxidised low-density lipoprotein induced a procoagulant response in cultured ECV304 cells and increased the number of adhering Jurkat cells, but adhesion was not inhibited by pretreating ECV304 cells with annexin V. PS was not significantly exposed on untreated Jurkat cells, as determined by flow cytometry with annexin V-FITC. However, after adhesion to thrombin-treated ECV304 cells for 10 min followed by detachment in 1 mM EDTA, there was a marked exposure of PS on the Jurkat cells. Binding of annexin V-FITC to the detached cells was inhibited by pretreating them with unlabelled annexin V. Contact with thrombin-treated ECV304 cells thus induced the exposure of PS on Jurkat cells and, as Jurkat cells were unable to adhere to thrombin-treated ECV304 cells in the presence of EGTA, the adhesion of the two cell types may involve a Ca(2+) bridge between PS on both cell surfaces. The number of T cells from normal, human peripheral blood that adhered to ECV304 cells was not increased by treating the latter with thrombin. However, findings made with several T cell lines were generally, but not completely, consistent with the possibility that adhesion to surface PS on endothelial cells may be a feature of T cells that express both CD4(+) and CD8(+) antigens. Possible implications for PS-dependent adhesion of T cells to endothelial cells in metastasis, and early in atherogenesis, are discussed.

Annexin A5↗
PubMed2000

Approaches to changing the use of time in a public hospital.

This article describes a qualitative study that used documentary sources and interviews with a cross-section of clinical managers and staff to identify the ways in which use of time changed in two clinical units following the introduction of casemix-based funding in Victoria. For staff at all levels within the hospital system, changes in the use of time were experienced that affected both the organisation of work and the care provided. The two units approached the management of time in different ways. From the introduction of casemix-based funding to the conclusion of this study there were improvements in efficiency in both clinical units. The case studies are compared and the consequences of different approaches to managing time in clinical units are described.

Diagnosis-Related Groups↗
PubMed2000

An analysis of an inflammatory bowel disease practice in an urban community hospital.

OBJECTIVES: To review an individual community gastroenterologist's experience with inflammatory bowel disease (IBD). The aspects studied were distribution of disease, need for hospital admission, immunosuppressants, systemic steroids, and surgery and its indications. The incidence of cancer was also reviewed. PATIENTS AND METHODS: The charts of all IBD patients (n=373) seen between 1993 and 1996 by an individual gastroenterologist in an urban community hospital were reviewed for the aforementioned information. Patients seen during this period may have been diagnosed with IBD before or during the period of 1993 to 1996. RESULTS: Of the 373 patients, 219 had Crohn's disease (CD) and 154 had ulcerative colitis (UC). The most common age of onset for both groups was 20 to 29 years. Distal UC and distal Crohn's colitis patients rarely required surgery, hospitalization, systemic steroids or immunosuppressants. Eighty per cent of patients with small bowel CD and 51% of those with ileocolonic CD required at least one operation. Of the UC patients, 10.4% required surgery. Of the UC patients undergoing surveillance for cancer, none developed cancer but one developed significant dysplasia. CONCLUSIONS: In both CD and UC the site of the inflammation plays a major role in determining the need for hospitalization, surgery, systemic steroids and immunosuppressants. Distal UC, the most common form of UC in this group of patients, is a very benign disease. Of all forms of IBD, small bowel CD had the greatest need for hospitalization, surgery and systemic steroids.

Adult↗
PubMed2000

Assessment of shoulder strength in professional baseball pitchers.

STUDY DESIGN: A bilateral comparison of strength and range of motion testing in professional baseball pitchers. OBJECTIVE: We studied 39 professional male baseball pitchers to determine if the shoulder used for throwing was weaker or had less passive range of motion, compared to the nondominant arm. BACKGROUND: Shoulder muscle weakness has been proposed as a possible risk factor for developing injury. Therefore, objective quantification of the strength of glenohumeral and scapular rotator muscle groups should be studied in a population of professional baseball pitchers. METHODS AND MEASURES: Passive internal and external range of motion was bilaterally measured at 90 degrees of abduction. Muscle strength of the following muscles was measured bilaterally with a hand-held dynamometer: external and internal glenohumeral rotators, supraspinatus, middle trapezius, lower trapezius, and serratus anterior. RESULTS: Passive external rotation of the glenohumeral joint at 90 degrees of abduction on the pitching side was significantly greater than on the nonpitching side. Passive internal rotation range of motion on the nonpitching side was significantly greater than on the pitching side. The pitching arm's internal rotators, when tested in abduction, were significantly stronger than the nonpitching arm. The nonpitching arm's external rotators in the plane of the scapula, and in abduction, were significantly greater than those of the pitching arm. The pitching arm's middle and lower trapezius muscles were significantly stronger than those of the nonpitching arm. CONCLUSION: The range of motion and strength characteristics measured in this study can assist clinicians in evaluating athletes who use overhead throwing motions.

Adolescent↗
PubMed1999

The Gap effect for spatially oriented responses.

The gap effect refers to the finding that a temporal gap between fixation point offset and target onset typically results in shorter saccadic latencies than if the fixation point remains on. Recently, this gap effect was found for aimed hand movements as well as saccadic eye movements, but not for simple keypress responses. In order to examine the hypothesis that the hand gap effect occurs for different types of spatially oriented movements, two experiments were conducted. In the first experiment, subjects produced spatially oriented responses to a peripheral target and the target location was known in advance of the targets presentation. This spatially oriented detection task yielded gap effects for both eye and hand responses. In the second experiment, the duration of the temporal gap was varied between 0-400 ms. The duration of the temporal gap had similar effects on the magnitudes of both the eye and hand gap effects, suggesting that a common mechanism may underlie the gap effect for saccadic and manual pointing movements. Overall, the results of the present experiments confirm the finding of a gap effect for spatially oriented hand movements and suggest that this effect may be related to the functioning of the superior colliculus.

Fixation, Ocular↗
PubMed1999

Energy restriction modulates the development of advanced preneoplastic lesions depending on the level of fat in the diet.

Our objective was to investigate the ability of preneoplastic colonic lesions at different stages of development to respond to the growth-retarding effects of energy restriction (ER). Male Fischer 344 rats were given three injections of azoxymethane (15 mg/kg s.c.) and fed a high-fat corn oil diet for 16 weeks. This duration allowed aberrant crypt foci (ACF) to develop and acquire different growth states. ACF growth was assessed by enumerating the number of crypts per focus. At Week 16, 10 animals were killed and their colons were enumerated for ACF (baseline). The remaining animals were then allocated to four dietary groups: high-fat (23% wt/wt), low-fat (5% wt/wt), high-fat energy-restricted (HFER), or low-fat energy-restricted (LFER). After the animals were fed the experimental diets for six weeks, ER decreased the total number of ACF regardless of the level of fat. At Week 12, the LFER diet retarded the appearance of advanced ACF, but this was not the case for the HFER diet. Consequently, the level of fat was identified as the significant variable in affecting the number of ACF with different crypt multiplicity. The animals fed the LFER diet had the fewest tumors and microadenomas per rat. The HFER diet was ineffective in modulating tumor outcome. To our knowledge, these findings are the first to suggest that ER modulated the development of advanced ACF and colonic tumors depending on the level of fat in the diet.

Analysis of Variance↗
PubMed1999

[Antibacterial peptides isolated from the urine of healthy adults].

Gel chromatography on Sephadex G-25, DEAE Sephadex A-25 and electrophoresis were used for isolation of two peptides from urine of healthy adults. Isolated peptides exhibited a higher antibacterial activity than antibiotics penicillin and tetracycline. The inhibitory zone of these peptides is similar to that of ampicillin. Chemical analysis of the isolated peptides revealed that one is composed of 5 and the other of 7 amino acids. In both peptides was the concentration of glycine the highest from all amino acids. the highest. (Tab. 1, Fig. 4, Ref. 22.)

Adult↗
PubMed1998

Galactosphingolipids and axono-glial interaction in myelin of the central nervous system.

The myelin of central and peripheral nervous system of UDP-galactose-ceramide galactosyltransferase deficient mice (cgt-/-) is completely depleted of its major lipid constituents, galactocerebrosides and sulfatides. The deficiency of these glycolipids affects the biophysical properties of the myelin sheath and causes the loss of the rapid saltatory conduction velocity of myelinated axons. With the onset of myelination, null mutant cgt-/- mice develop fatal neurological defects. CNS and PNS analysis of cgt-/- mice revealed (1) hypomyelination of axons of the spinal cord and optic nerves, but no apoptosis of oligodendrocytes, (2) redundant myelin in younger mice leading to vacuolated nerve fibers in cgt-/- mice, (3) the occurrence of multiple myelinated CNS axons, and (4) severely distorted lateral loops in CNS paranodes. The loss of saltatory conduction is not associated with a randomization of voltage-gated sodium channels in the axolemma of PNS fibers. We conclude that cerebrosides (GalC) and sulfatides (sGalC) play a major role in CNS axono-glial interaction. A close axono-glial contact is not a prerequisite for the spiraling and compaction process of myelin. Axonal sodium channels remain clustered at the nodes of Ranvier independent of the change in the physical properties of myelin membrane devoid of galactosphingolipids. Increased intracellular concentrations of free ceramides do not trigger apoptosis of oligodendrocytes.

Animals↗
PubMed1998

Collaborative relationships in general practice projects.

This article reports on a national study of collaborative relationships between general practitioners and other health care providers in 20 Division of General Practice projects. It argues that health care organisations will need to collaborate with others in the future and that much can be learnt from the literature on collaborative networks in business and community organisations. Successful collaborations between general practitioners and others were found to be consistent with a model of collaboration in 'under-organised domains', where pre-existing links between organisations are weak. Lessons are identified from the study to assist future collaborative ventures involving general practitioners.

Australia↗
PubMed1998

Diverse effect of fish oil on the growth of aberrant crypt foci and tumor multiplicity in F344 rats.

The main objective of the present study was to investigate the amenability of preneoplastic lesions at different developmental stages to the growth-regulatory effects of two types of dietary lipids. F344 male rats were given three injections of azoxymethane (15 mg/kg) and fed a low-fat corn oil diet for 12 weeks to allow preneoplastic lesions or aberrant crypt foci (ACF) to develop. At this time, the colons of rats had a large number of ACF exhibiting various crypt multiplicities (number of crypts/focus). These rats were then randomly allocated to three dietary groups: high-fat corn oil (HFC), high-fat fish oil (HFF), and low-fat corn oil (LFC). The number and crypt multiplicity of ACF and adenomatous lesions were determined after 6 and 12 weeks of dietary intervention. After six weeks, the HFF group had the highest number of ACF of all crypt multiplicities and microadenomas among the dietary groups. After 12 weeks of feeding, the HFC diet increased the number of tumors without significantly changing the number of ACF. In contrast, the HFF diet increased significantly (p < 0.05) the number of ACF with higher crypt multiplicity without affecting the number of tumors. Consequently, the total number of tumors per group in decreasing order was as follows: HFC > LFC > HFF. These findings suggest that dietary lipids varying in fatty acid composition, namely corn oil and fish oil, exerted a growth-enhancing and -inhibiting effect, respectively, on different preneoplastic stages in a selective and differential manner. Most notably, transition of microscopic preneoplastic lesions to macroscopic lesions (microadenomas or adenomas) appears to be retarded by an HFF diet.

Animals↗
PubMed1998

Sun-protective clothing.

BACKGROUND: Topical sunscreens have been used for many years on exposed areas (i.e., hands, face) to protect the skin from the damaging effects of ultraviolet radiation. Most people do not use sunscreens on their bodies when they are wearing clothes. An average weight cotton T shirt gives only a sun protection factor (SPF) of 7. This is inadequate protection when out of doors. Therefore, clothing with adequate sunscreening properties should be worn. OBJECTIVE: The purpose of this study is to identify the factors in clothing fabrics that contribute to or detract from blocking ultraviolet radiation and to recommend criteria for establishing a standard for sunprotective clothing. METHOD: The study involves a review of the dermatologic and textile literature to identify various factors in fabrics that contribute to blocking ultraviolet radiation through textiles. CONCLUSION: For fabrics, the term ultraviolet protection factor (UPF) is used as the measure of ultraviolet radiation penetration through the fabric. The UPF of a fabric depends upon fiber content and weave, fabric colour, finishing processes, and the presence of additives. The performance of a fabric depends upon stretching, shrinkage, hydration, laundering, and wear of the fabric over time. Based upon these criteria the minimum CDA standard UPF for clothing should be 40 to 50+.

Clothing↗