Tension pneumothorax in the presence of bilateral intercostal chest drains.
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Adult↗
Biomedical subjects
J Davis
Publications and source records attributed to J Davis.
A neuropsychological study of panic disorder: negative findings.
BACKGROUND: Gray (1982) proposed that the septo-hippocampal system, which plays an important role in learning and memory, may partially mediate anxiety. Thus, patients with anxiety disorders may manifest neurocognitive performance deficits. We hypothesized that patients with panic disorder would demonstrate learning and memory deficits relative to normal comparison subjects. METHOD: Comprehensive neuropsychological batteries were administered to 69 panic disorder subjects and 19 normal volunteers. RESULTS: There were no significant group differences in any neuropsychological performance domain including learning, memory, attention, visuospatial functioning, and psychomotor speed. Multiple regression conducted to evaluate the contribution of clinical symptoms to neuropsychological impairment within the panic disorder sample revealed that anxiety severity did not affect neuropsychological test performance. LIMITATIONS: Most patients had mild or moderate, rather than severe, panic disorder. CONCLUSION: Neuropsychological dysfunction was not associated with panic disorder.
Adolescent↗
Cellular mechanisms of resistance to chronic oxidative stress.
Oxidative stress is implicated in several pathologies such as AIDS, Alzheimer's disease, and Parkinson's disease, as well as in normal aging. As a model system to study the response of cells to oxidative insults, glutamate toxicity on a mouse nerve cell line, HT-22, was examined. Glutamate exposure kills HT-22 via a nonreceptor-mediated oxidative pathway by blocking cystine uptake and causing depletion of intracellular glutathione (GSH), leading to the accumulation of reactive oxygen species and, ultimately, apoptotic cell death. Several HT-22 subclones that are 10-fold resistant to exogenous glutamate were isolated and the mechanisms involved in resistance characterized. The expression levels of neither heat shock proteins nor apoptosis-related proteins are changed in the resistant cells. In contrast, the antioxidant enzyme catalase, but not glutathione peroxidase nor superoxide dismutase, is more highly expressed in the resistant than in the parental cells. In addition, the resistant cells have enhanced rates of GSH regeneration due to higher activities of the GSH metabolic enzymes gamma-glutamylcysteine synthetase and GSH reductase, and GSH S-transferases activities are also elevated. As a consequence of these alterations, the glutamate resistant cells are also more resistant to organic hydroperoxides and anticancer drugs that affect these GSH enzymes. These results indicate that resistance to apoptotic oxidative stress may be acquired by coordinated changes in multiple antioxidant pathways.
Animals↗
Constant temperature monitoring: a study of temperature patterns in the postanesthesia care unit.
Patients admitted to the PACU from the operating room exhibit fluctuations in core body temperature during the course of their stay in the PACU. Some patients present with normothermia and experience temperature decreases later in their stay. PACU policy does not dictate that temperatures be measured at a predetermined frequency in the absence of hypothermia; thus, it is possible that hypothermia may not be detected at its onset. The major purpose of this study was to describe the core body temperature patterns of postsurgical patients during the PACU stay. Secondary objectives were to (1) identify at which point in time patients become hypothermic and (2) describe length of stay in patients who develop hypothermia. Hypothermia was defined as a core tympanic temperature of less than 35.5 degrees C. A descriptive design was used using a convenience sample of 150 elective surgical patients over the age of 1 month who were normothermic on admission to the PACU. Data were analyzed using descriptive statistics. Concurrent tympanic and continuous axillary temperatures were monitored for comparison and trend monitoring. Temperatures showed clinically significant decreases into the hypothermic range (< 35.5 degrees C). Fifty-seven percent of the sample (n = 86) had temperatures that dropped after PACU admission and another 13% fell below 35.5 degrees C. Hypothermia occurred within the first 15 minutes of the PACU stay. The average length of stay for those that developed hypothermia was 1.83 hours. Monitoring temperatures more frequently will result in detecting hypothermia at its onset. Nurses may use the axillary device as a trend for continuous monitoring. Length of stay may be shortened if temperature management is embraced by the PACU nurse.
Adolescent↗
High-dose etoposide with granulocyte colony-stimulating factor for mobilization of peripheral blood progenitor cells: efficacy and toxicity at three dose levels.
High-dose etoposide (2.0-2.4 g m(-2)) with granulocyte colony-stimulating factor (G-CSF) is an effective strategy to mobilize peripheral blood progenitor cells (PBPCs), although in some patients this is associated with significant toxicity. Sixty-three patients with malignancy were enrolled into this non-randomized sequential study. The majority (55/63, 87%) had received at least two prior regimens of chemotherapy, and seven patients had previously failed to mobilize following high-dose cyclophosphamide with G-CSF. Consecutive patient groups received etoposide at three dose levels [2.0 g m(-2) (n = 22), 1.8 g m(-2) (n = 20) and 1.6 g m(-2) (n = 21)] followed by daily G-CSF. Subsequent leukaphereses were assayed for CD34+ cell content, with a target total collection of 2.0 x 10(6) CD34+ cells kg(-1). Toxicity was assessed by the development of significant mucositis, the requirement for parenteral antibiotics or blood component support and rehospitalization incidence. Ten patients (16%) had less than the minimum target yield collected. Median collections in the three groups were 4.7 (2 g m(-2)), 5.7 (1.8 g m(-2)) and 6.5 (1.6 g m(-2)) x 10(6) CD34+ cells kg(-1). Five of the seven patients who had previously failed cyclophosphamide mobilization achieved more than the target yield. Rehospitalization incidence was significantly lower in patients receiving 1.6 g m(-2) etoposide than in those receiving 2.0 g m(-2) (P = 0.03). These data suggest that high-dose etoposide with G-CSF is an efficient mobilization regimen in the majority of heavily pretreated patients, including those who have previously failed on high-dose cyclophosphamide with G-CSF. An etoposide dose of 1.6 g m(-2) appears to be as effective as higher doses but less toxic.
Acute Disease↗
Presenilins--in search of functionality.
The discovery of the PS proteins, the complexities of their biochemistry and their potential involvement in signalling pathways and in apoptosis have galvanized research into AD. To date, the aspect of the functionality of the PSs most relevant to the pathology of AD is the effect of PS FAD mutants to increase the proportion of A beta 42 produced from cells. This, coupled to the observation that gamma-secretase cleavage is considerably reduced in neurons derived from PS-1 knockout mice, argues strongly that PS plays a very direct role in the proteolytic processing of APP.
Alzheimer Disease↗
Dietary fish oil suppresses human colon tumour growth in athymic mice.
1. Human colon tumour growth, initiated by subcutaneous inoculation of HT29 cells, was measured in athymic mice fed ad libitum on high-fat (210 g/kg) diets rich in coconut oil (CO), olive oil (OO), safflower oil (SO) or fish oil (FO); a low fat (LF; 25 g/kg) diet was used as the control. In one experiment the mice were fed the experimental diets for 3 weeks before HT29 cell inoculation and were killed 2 weeks post-inoculation. In a second experiment the mice were maintained on the LF diet until 4 days post-HT29 cell inoculation; they were then fed the experimental diets for 17 days. 2. Compared with mice fed the LF diet, tumour size was increased in mice fed the CO, OO or SO diets for 3 weeks before HT29 cell inoculation; FO feeding did not significantly increase tumour size. 3. Feeding mice the CO or OO diets from 4 days post-inoculation increased tumour growth rate and tumour size compared with feeding the LF, SO or FO diets; tumour growth rate and size did not differ among mice fed the latter diets. 4. The fatty acid composition of the tumours was markedly influenced by the fatty acid composition of the diet. 5. We conclude that human colon tumour growth is influenced by the type of fat consumed in the diet. Human colon tumour growth in this model is promoted by feeding high fat diets rich in medium chain saturated fatty acids (CO) or monounsaturated fatty acids (OO). A high fat diet, rich in long chain n - 3 polyunsaturated fatty acids (FO), does not promote colon tumour growth. The effect of a high fat diet rich in n - 6 polyunsaturated fatty acids (SO) depends upon the time at which it is fed: if fed before tumour cell inoculation such a diet promotes tumour growth, whereas if fed once tumour growth is initiated it does not. This suggests that n - 6 polyunsaturated fatty acids promote the initiation of colon tumour growth, but do not exert growth-promoting effects on colon tumours once they are established.
Adipose Tissue↗
Synthesis and antiviral evaluation of pyrazinones substituted with acyclic chains.
The synthesis of a series of pyrazine analogues of the anti-herpes compound, acyclovir is described. These syntheses were accomplished by various methods: in the presence of a Lewis acid or NaH for hydroxyethoxymethyl and hydroxybutyl groups or by sequential oxidation/reduction of 1-(beta-D-ribofuranosyl)-2-pyrazinones for 2',3'-acyclonucleosides. Antiviral (HSV-1, CMV, Cox B4, HIV-1) properties of these compounds were determined.
Antiviral Agents↗
Potential antiviral agents. Part II. Synthesis and antiviral evaluation of pyrazinones substituted with acyclic chains.
The synthesis of a series of 4'-substituted hydroxybutyl pyrazine analogues of the anti-herpes compound, acyclovir, is described. The compounds were characterized with 1H and 13C nmr, mass and IR spectroscopy. Antiviral (HSV-1, CMV, Cox B4, HIV-1) properties of these compounds were examined. None of these compounds were active against these viruses.
Acyclovir↗
Adiposity and blood pressure in a multiethnic population of women in Hawaii.
OBJECTIVE: To compare the amount and distribution of fat among White, Japanese, Filipino and Hawaiian women and to investigate associations between measures of adiposity and serum cholesterol and blood pressure. DESIGN: Cross-sectional survey of adiposity, serum cholesterol and blood pressure of 421 volunteer women of White (N = 137), Japanese (N = 144), Filipino (N = 74) and Hawaiian (N = 66) ethnicities, age 25-35 years. Anthropometric measures (weight; height; subscapular, bicep, tricep, suprailiac and calf skinfold thickness; waist, hip and mid-upper arm circumferences), grip strength, serum cholesterol and blood pressure. RESULTS: Hawaiian women had the highest levels of adiposity by all measures. Asian women (especially Filipinos) had higher subscapular skinfold thicknesses than did Whites and, for the same value of body mass index (BMI), had a greater percentage of body fat. BMI was the strongest correlate of systolic blood pressure, while subscapular skinfold thickness was the strongest correlate of diastolic blood pressure. Blood pressure varied by adiposity but not ethnicity. No measures of body fat were associated with serum cholesterol. CONCLUSION: Higher body fat measures, especially BMI, were associated with higher systolic blood pressure. However, higher subscapular skinfold (upper body) thickness was also associated with higher diastolic blood pressure. Subscapular fatness appears to be especially important among women of Asian ethnicity, Filipino women in particular.
Adult↗
Voluntary guidance for the development of tissue-engineered products.
Tissue Engineering is an emerging field of medical research in which there is tremendous activity. Many of these products rely on the use of a cellular component co-formulated with a natural or synthetic biomaterial. At this time, though, there are no consensus safety or efficacy standards for tissue-engineered products. We describe general approaches for assessment of the safety and efficacy of cell-based tissue-engineered products which will lead to reliable medical products for human use. This article provides a general summary of the factors that should be considered in the design and development of cell- and tissue-based products. Seven areas are considered: cell and tissue sourcing; cell and tissue characterization; biomaterials testing; quality assurance; quality control; and nonclinical testing and clinical evaluation. Factors relevant to these areas have been discussed to provide a set of recommendations on which development of products can be standardized. Where relevant, the discussion has been separated in each area to issues that are independent or dependent on cell source. Also, examples are provided of how these guidelines would be applied to two product types that represent somewhat extreme ends of the spectrum for tissue engineering applications. The first example is a product whose mechanism of action is to provide locally-acting structural repair or enhancement in vivo. The second example is a product whose mechanism of action involves systemically distributed physiologically or pharmacologically active products. In general, we have limited the discussion of product types to those that are implanted into the patient for relatively long periods of time. We believe that adoption of these voluntary guidelines would lead to products that are more consistent in quality and performance as well as more rapidly developed.
Animals↗
The role of the nurse in cancer genetics.
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Clinical Competence↗
Prevention of acute inducible atrial flutter in dogs by using an ibutilide-polymer-coated pacing electrode.
Atrial arrhythmias (atrial fibrillation or atrial flutter) after coronary artery bypass graft surgery are difficult to prevent or treat and often result in significant morbidity. Prior experimental studies by our group showed improved therapeutic efficacy for antiarrhythmic drugs delivered via controlled-release polymeric matrices implanted on the epicardial surface. These experiments were conducted to test the hypothesis that direct atrial epicardial administration of ibutilide from a controlled-release system (compared with intravenous administration) can reduce the inducibility of atrial flutter in the acute postoperative atrial myocardium. Polymeric sustained-release preparations were formulated by solvent casting of an ibutilide and polyurethane (Pellathane) solution in tetrahydrofurane. Multilayer solvent-casted coatings on pacing electrode wires were carried out to fabricate a sustained-release electrode system. In animal model studies, each dog underwent a thoracotomy, followed by a right atriotomy that was repaired. Induction of atrial flutter was attempted by burst pacing with the bipolar pacing catheter. Sinus rhythm was restored with overdrive pacing. After determining the induction rate (percentage) of atrial flutter in the baseline state, a stainless-steel wire coated with the drug-delivery system, 10% ibutilide/90% polyurethane (n = 7), or without drug (polyurethane coating without ibutilide, n = 5; control) was sewn onto the right atrium. Systemic intravenous administration of ibutilide (1.2 microg/kg/h) also was carried out in a separate group of animals after atriotomy (n = 5). For ibutilide (at an estimated dose of 1.2 microg/kg/h), the atrial-flutter results were 41.85 +/- 2.21% induction for baseline compared with 12.42 +/- 5.26% (p = 0.02) after the ibutilide wire implant. In the control dogs, atrial flutter was induced 29.4 +/- 4.7% at baseline and 25.2 +/- 5.1% after implantation of the control wire (p = 0.4). Ibutilide coronary venous serum concentrations at the end of the ibutilide-polyurethane electrode experiments were 2.25 +/- 0.2 ng/ml (mean +/- SEM) versus systemic levels that were below the limits of detection. Systemic intravenous ibutilide infusions had no effect on the inducibility of atrial flutter. In conclusion, an epicardial implantable electrode coating with an ibutilide controlled drug-release system significantly reduced the inducibility of atrial flutter in an experimental atriotomy model. These results suggest that atrial arrhythmias occurring after coronary bypass surgery may be prevented by local atrial administration of ibutilide from a controlled-release pacing electrode.
Animals↗
CCU patient survey tool: all-out recovery.
Studies show that patients' recall of their CCU stays is extremely limited due to various factors. To monitor patient satisfaction in this area, a team of CCU managers developed a survey and began an "All-Out Recovery Program."
Coronary Care Units↗
Effect of ventricular shock strength on cardiac hemodynamics.
INTRODUCTION: The effect of implantable defibrillator shocks on cardiac hemodynamics is poorly understood. The purpose of this study was to test the hypothesis that ventricular defibrillator shocks adversely effect cardiac hemodynamics. METHODS AND RESULTS: The cardiac index was determined by calculating the mitral valve inflow with transesophogeal Doppler during nonthoracotomy defibrillator implantation in 17 patients. The cardiac index was determined before, and immediately, 1 minute, 2 minutes, and 4 minutes after shocks were delivered during defibrillation energy requirement testing with 27- to 34-, 15-, 10-, 5-, 3-, or 1-J shocks. The cardiac index was also measured at the same time points after 27- to 34-, and 1-J shocks delivered during the baseline rhythm. The cardiac index decreased from 2.30 +/- 0.40 L/min per m2 before a 27- to 34-J shock during defibrillation energy requirement testing to 2.14 +/- 0.45 L/min per m2 immediately afterwards (P = 0.001). This effect persisted for > 4 minutes. An adverse hemodynamic effect of similar magnitude occurred after 15 J (P = 0.003) and 10-J shocks (P = 0.01), but dissipated after 4 minutes and within 2 minutes, respectively. There was a significant correlation between shock strength and the percent change in cardiac index (r = 0.3, P = 0.03). The cardiac index decreased 14% after a 27- to 34-J shock during the baseline rhythm (P < 0.0001). This effect persisted for < 4 minutes. A 1-J shock during the baseline rhythm did not effect the cardiac index. CONCLUSION: Defibrillator shocks > 9 J delivered during the baseline rhythm or during defibrillation energy requirement testing result in a 10% to 15% reduction in cardiac index, whereas smaller energy shocks do not affect cardiac hemodynamics. The duration and extent of the adverse effect are proportional to the shock strength. Shock strength, and not ventricular fibrillation, appears to be most responsible for this effect. Therefore, the detrimental hemodynamic effects of high-energy shocks may be avoided when low-energy defibrillation is used.
Adult↗
Molecular epidemiology of Staphylococcus aureus and Enterococcus faecalis in endophthalmitis.
Genomic DNA fingerprint analysis was performed on 39 Staphylococcus aureus and 28 Enterococcus faecalis endophthalmitis isolates collected from multiple clinical centers. Among 21 S. aureus genomic DNA fingerprint patterns identified, five clonotypes were recovered from multiple unrelated patients and accounted for 58.9% (23 of 39) of the isolates analyzed. Compared with strains having unique genomic DNA fingerprint patterns, the S. aureus clonotypes occurring more than once were more likely to result in visual acuities of 20/200 or worse (P = 0.036 [chi2 test]). In contrast to the S. aureus isolates, the E. faecalis endophthalmitis isolates were a clonally diverse population, enriched for the expression of a known toxin, cytolysin, which is plasmid encoded.
Bacterial Typing Techniques↗
Effect on attendance at breast cancer screening of adding a self administered questionnaire to the usual invitation to breast screening in southern England.
STUDY OBJECTIVE: The primary aim of the research described in this paper was to ascertain whether inclusion of a self administered questionnaire with the usual invitation to routine breast screening affected screening uptake. Secondary aims included establishing appropriate questionnaire distribution and collection methods within the framework of the National Health Service Breast Screening Programme and optimisation of questionnaire design. DESIGN: Randomised study. SETTING: Oxfordshire and West of London Breast Screening Units. PARTICIPANTS/METHODS: 6400 women invited for routine screening mammography were individually randomised to receive either the usual breast screening invitation alone, or to receive the usual invitation accompanied by a self administered questionnaire, to be returned at the time of screening. Participants were then followed up and attendance rates at screening were compared between groups. MAIN RESULTS: Screening attendance rates were similar in women who did and did not receive a questionnaire (71% in each group). Of those who were sent a questionnaire and attended for screening, 77% returned a completed questionnaire. Screening uptake was not affected by the way in which the questionnaire was returned or by whether or not personal details and signed permission for follow up were requested. CONCLUSIONS: The inclusion of a self administered questionnaire accompanying the invitation to breast screening did not adversely affect screening uptake. A high proportion of women completed the questionnaire.
Breast Neoplasms↗
Hydrogel dressings not to be used on infected tissue.
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Contraindications↗