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Biomedical subjects

J Dunn

Publications and source records attributed to J Dunn.

At least 127 records · Page 7Linked to original sources
PubMed1994

Adjustment in middle childhood and early adolescence: links with earlier and contemporary sibling relationships.

The relation of individual differences in internalizing and externalizing behavior in middle childhood and early adolescence to children's concurrent sibling relationships and their mothers' mood, and to their sibling and mother-child relationships in the preschool period was studied. Thirty-nine younger and 39 older siblings observed at home in the preschool period were studied 5 and 7 years later. Differences in adjustment were related to contemporary sibling relationships and maternal mood, and to sibling and mother-child interaction in the preschool period, even when mothers' current mood was taken into account.

Adaptation, Psychological↗
PubMed1994

Cigarette smoking and histological outcome in women with mildly dyskaryotic cervical smears.

OBJECTIVE: To determine which patient related variables, available at the point of referral, predict the presence of high grade intraepithelial neoplasia when the smear result is mild dyskaryosis with or without co-existent koilocytosis. DESIGN: Multivariate analysis of prospective programme trial. SETTING: Academic Department Colposcopy clinics at Dudley Road Hospital, Birmingham, UK. SUBJECTS: One hundred and sixty-seven women, whose worst ever cervical smear was mild dyskaryosis with or without koilocytosis, referred to colposcopy clinics. All the women had complete data sets, as determined by the format of an ongoing programme, and all were treated by diathermy loop excision of the cervical transformation zone. MAIN OUTCOME MEASURES: Age, parity, contraceptive practice, smoking habit, duration of abnormal cytology and the grade of histology in the excised transformation zone. RESULTS: Forty-seven out of 78 (60%) smokers, compared with 18 out of 73 (25%) nonsmokers, had high grade disease. The other variables considered in the analysis were not significant or very weakly associated with histological grade when analysed in a univariate analysis. Stepwise logistic regression identified cigarette smoking as a powerful independent predictor of high grade disease. CONCLUSION: These data suggest a strong association between smoking and high grade intraepithelial neoplasia in a population of women whose worst ever smear report was mild dyskaryosis. Smoking is a variable that could be built into models to facilitate referral for colposcopic assessment.

Adolescent↗
PubMed1994

Doxorubicin-induced cardiomyopathy.

Doxorubicin (Adriamycin; Adria Laboratories, Columbus, OH) is one of the most effective chemotherapeutic agents used in the management of pediatric neoplastic disorders during the past 20 years. However, its use has been limited by well-characterized, dose-related cardiac toxicity. Recently, cardiac dysfunction has been noted in pediatric patients who had received doxorubicin years before. This article summarizes current information regarding the pathophysiology and risk factors associated with cardiotoxicity and reviews detection methods and treatments of this condition.

Adult↗
PubMed1994

[Capture and recapture method: a new methodology for epidemiological research].

Although capture-recapture method is not new, their use in epidemiological studies has so far been limited. The method was developed by animal ecologists to estimate the size of various species populations, but in recent years it has been used to measure the incidence and prevalence of a variety of non-communicable diseases. Capture-recapture allows more accurate estimates to be made than is the case with traditional methods and is more cost-effective. The method is ideally suited to studying rare or elusive populations, such as intravenous drug misusers; but they are highly adaptable and have been used to study populations as diverse as street working prostitutes and the human red-cell volume. The objectives of this review are to explain the mathematical theory behind capture-recapture, give examples of its use and application in clinical epidemiology and out line some of the modifications that have been made to the theory, which take into account the complex nature of samples used in clinical research. An increasing number of medical epidemiologists have started to use the method, and its potential for future epidemiological research is enormous.

Epidemiologic Methods↗
PubMed1994

Promoting quality mental health care delivery with critical path care plans.

1. Mental Health providers are under increasing pressure to provide objective, individualized care that produces outcomes that may be measured against accepted clinical standards. 2. Clinicians may now track patient responses throughout a continuum of treatment in varying locations by using a customized critical path/treatment plan format. 3. Care delivery is documented by superimposing actual occurrences over desired ones on a critical pathway.

Continuity of Patient Care↗
PubMed1994

Cytokine involvement in predicting clinical graft-versus-host disease in allogeneic bone marrow transplant recipients.

An in vitro skin explant model has been used to predict the severity of acute graft-versus-host disease (GVHD) in 34 HLA-identical bone marrow transplant recipients (correlation coefficient 0.6 p < 0.001). Supernatants from HLA-matched patient/donor mixed lymphocyte cultures (MLCs) were analysed for levels of tumour necrosis factor alpha (TNF alpha) and interferon gamma (IFN gamma). High levels of both cytokines correlated with the development of GVHD grades II or above (p < 0.05). The supernatants were also tested for induction of class II MHC antigen expression on third party skin and results correlated with clinical outcome in 17 of 22 cases (77%) (correlation coefficient 0.65, p < 0.001). The results suggest that measurement of both TNF alpha and IFN gamma in HLA-matched MLC supernatants is of predictive value and that the skin explant model is a useful model for studying the aetiology of GVHD in humans.

Adolescent↗
PubMed1994

Direct composite or bonded porcelain: a clinical choice for anterior aesthetics.

Choosing between direct composite resins and bonded porcelain veneers to restore permanent anterior teeth requires the dentist to evaluate both the aesthetic potential and the functional reliability of available bonding procedures. Direct composites are aesthetic, conservative and reliable, but demand technical and artistic skills, and have limited longevity. Bonded porcelain veneers can have excellent aesthetics, but require additional tooth preparation, exacting technique and laboratory support, and have an unknown life expectancy.

Age Factors↗
PubMed1993

Effect of pravastatin on metabolic parameters of apolipoprotein B in patients with mixed hyperlipoproteinemia.

3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce plasma cholesterol in different forms of hyperlipoproteinemia. Although an increase in low-density lipoprotein (LDL) receptor activity is the proven mechanism of this therapy in familial hypercholesterolemia, the mechanism remains controversial in mixed hyperlipoproteinemia. A decreased production of apolipoprotein B (apoB) and/or an increased removal of lipoproteins could mediate the hypocholesterolemic effect of these drugs. The effect of pravastatin on the metabolism of apoB was evaluated in a randomized, double blind, placebo controlled, cross-over study in five men with mixed hyperlipoproteinemia. Metabolic parameters for apoB were determined using endogenous labeling with [1-13C]leucine and [15N]glycine and multicompartmental modeling. During pravastatin therapy cholesterol, LDL cholesterol, apoB, and LDL apoB levels were significantly reduced (P < 0.01) by 18%, 20%, 27%, and 29%, respectively, while triglyceride and high-density lipoprotein cholesterol levels remained unchanged. Pravastatin therapy increased the fractional catabolic rate of very low density lipoprotein apoB from 3.9 +/- 0.6 to 5.1 +/- 1.7 per day (P = 0.08) and that of LDL apoB from 0.37 +/- 0.09 to 0.46 +/- 0.10 per day (P < 0.01). The apoB production (placebo 35.2 +/- 11.9 mg/kg per day; pravastatin 25.8 +/- 8.7 mg/kg per day) and conversion of very low density lipoprotein apoB to LDL apoB (placebo 65%, pravastatin 57%) remained stable. Thus, also in mixed hyperlipoproteinemia 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors increase the catabolism of apoB-containing lipoproteins without significantly affecting the production of apoB.

Adult↗
PubMed1993

Pregnancy outcome after large loop excision of the cervical transformation zone.

OBJECTIVE: Our purpose was to determine whether large loop excision of the cervical transformation zone affects the outcome of pregnancy after 20 weeks' gestation. STUDY DESIGN: In a retrospective case control study 40 women who had undergone large loop excision of the cervical transformation zone and were subsequently delivered at Dudley Road Hospital were identified between January 1989 and January 1992. Eighty controls were identified and matched for age, parity, and ethnic group from women delivered immediately before and after index cases. Variables included maternal performance in labor and smoking habits and perinatal outcome. Maternal factors analyzed included pregnancy gestation, length of the first and second stages of labor, use of oxytocin, analgesia, mode of delivery, estimated blood loss, whether labor was spontaneous or induced, and if preterm spontaneous rupture of membranes occurred. Perinatal outcome measures included whether the infant was liveborn, fetal weight, the presence of fetal abnormalities, and admission to the neonatal unit. RESULTS: Women delivered after large loop excision of the cervical transformation zone had infants of significantly lower birth weight than did controls. They were also significantly more likely to have admitted to smoking on admission. CONCLUSION: Previous studies investigating pregnancy outcome after local destructive methods of treating cervical intraepithelial neoplasia have been generally reassuring. However, in this study women who were delivered after large loop excision of the cervical transformation zone had significantly smaller infants. Although this may be related to the characteristics of women who have cervical intraepithelial neoplasia (for example, their smoking habits), larger adequately controlled studies should be performed before colposcopists can be justified in adopting a liberal attitude to treating all women with abnormal smears.

Adult↗
PubMed1993

Increased viral titer through concentration of viral harvests from retroviral packaging lines.

Dependent on the viral vector and the specific assay used, viral titers produced from commonly used retroviral packaging cell lines have an upper limit in the range of 10(5) to 10(7) infectious units/ml. We have developed a generally applicable method, using hollow-fiber filtration technology, which allows for the concentration of infectious virus derived from packaging lines. This method resulted in a reproducible 10- to 30-fold increase in viral titer and can readily be scaled to accommodate larger input volumes. Over 80% of the input virus is recovered in an infectious form in the concentrate. Concentrated virus containing media was seen to produce higher infection frequencies in Jurkat T cells as compared to unconcentrated virus containing media; however, this was not proportional to the differences in viral titer observed by limiting dilution analysis on NIH-3T3 cells. These results are discussed in relation to the importance of factors other than viral titer in determining transduction frequencies.

3T3 Cells↗
PubMed1993

Serum thymidine kinase as a prognostic indicator for patients with multiple myeloma: results from the MRC (UK) V trial.

The significance of serum thymidine kinase (STK) as a prognostic indicator for patients with myeloma has been evaluated by determining the pre-treatment level of STK in a retrospective study of 547 patients from the Medical Research Council (MRC) V Myeloma Trial. Overall, STK was a highly significant prognostic factor (Chi 2 = 7.91; P = 0.005). At the time of censor, 23.4% of patients with a presentation STK of < 6 U/l but only 7.9% of the patients with an STK of > 11 U/l were still alive. STK proved to be a highly significant prognostic indicator for the 270 melphalan-treated patients (Chi 2 = 12.37; P = 0.0004) but had no prognostic significance for the 277 ABCM (adriamycin, BCNU, cyclophosphamide and melphalan) treated patients (Chi 2 = 0.29; P = 0.59). When the STK data was stratified for serum B-2-microglobulin (SB2M) it was demonstrated that STK was independent of SB2M and provided additional prognostic information for patients who were treated with melphalan. Thus patients with both a low STK and SB2M had the best prognosis (median survival 1677 d) and those patients with a high STK and SB2M had the worst prognosis (median survival 519 d). STK is a good prognostic marker for patients treated with melphalan but the prognostic significance of STK may disappear with the introduction of new chemotherapy regimens.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Treatment preferences of urologists in Great Britain and Ireland in the management of prostate cancer.

A questionnaire was sent to all full-time British and Irish urologists (n = 278) on the management of prostate cancer and was answered by 229 (82%). The questions included 3 specific clinical situations, namely the management of incidental disease, the timing of treatment for metastatic disease and the mode of hormonal manipulation used for advanced disease. It was found that 79% of urologists preferred a deferred treatment policy for incidental disease in the over-75 age group. Radical prostatectomy was advocated by 10% of those questioned for patients in the under-60 age group. Radiotherapy was the mainstay of treatment for incidental disease in the poorer prognosis groups of incidental disease, namely younger patients with more aggressive tumours. Most urologists treated patients with asymptomatic metastatic disease at the time of diagnosis, with 18% entering patients into the Medical Research Council trial comparing immediate with deferred therapy. Orchiectomy was advocated by 57% of urologists as their first-line treatment for patients where hormonal manipulation was indicated. Consequently orchiectomy should remain the "gold standard" in comparative phase III trials in advanced prostate cancer.

Attitude of Health Personnel↗
PubMed1993

Psychic conflict and the external world in Freud's theory of the instinctual drives in light of his adherence to Darwin.

Freud's theory of the instinctual drives is examined in the light of his adherence to Darwinian thought. In this scheme, the drives arise from the interaction between biological and environmental stimuli and are dialectically constructed from both pressures: internal and external phenomena reciprocally organise each other and attempts to conceptualise them as separate entities restrict the degree to which we can understand the nature of mental life. Inhibition that became built-in to biological stimuli redirected and 'elevated' these bodily urges to representational functioning, a phylogenetic process which developed from environmental demands in the species' struggle to survive. These ideas bear upon Freud's notion that ubiquitous mental conflict, environmental sensitivities, and primitive id and ego (including defence) organisations are inherent components of instinctual activity. This construction is compared to Freud's other models of the instinctual drives. The attitude conveyed by the metapsychological suppositions put forward is related to the clinical situation.

Biological Evolution↗
PubMed1992

Analysis and expression of the Borrelia burgdorferi P/Gau fla gene: identification of heterogeneity with the B31 strain.

The flagellin gene from the P/Gau strain of Borrelia burgdorferi was cloned and sequenced. The translated P/Gau flagellin protein differed from the flagellin of the B31 strain at 13 of 336 amino acids. This includes seven differences between amino acids 190-234, an immunodominant and specific region for B. burgdorferi. The entire flagellin molecule, as well as peptides of the internal portion of the protein which is more specific for B. burgdorferi, has been expressed in Escherichia coli using a pET7HIS.2 expression system. These peptides may be of great value for the development of sensitive and specific recombinant-based serological assays.

Amino Acid Sequence↗