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Biomedical subjects

J Evans

Publications and source records attributed to J Evans.

At least 181 records · Page 10Linked to original sources
PubMed1998

A vaccine consisting of recombinant Borrelia burgdorferi outer-surface protein A to prevent Lyme disease. Recombinant Outer-Surface Protein A Lyme Disease Vaccine Study Consortium.

BACKGROUND: Lyme disease is a multisystem inflammatory disease caused by infection with the tick-borne spirochete Borrelia burgdorferi and is the most common vector-borne infection in the United States. We assessed the efficacy of a recombinant vaccine consisting of outer-surface protein A (OspA) without adjuvant in subjects at risk for Lyme disease. METHODS: For this double-blind trial, 10,305 subjects 18 years of age or older were recruited at 14 sites in areas of the United States where Lyme disease was endemic; the subjects were randomly assigned to receive either placebo (5149 subjects) or 30 microg of OspA vaccine (5156 subjects). The first two injections were administered 1 month apart, and 7515 subjects also received a booster dose at 12 months. The subjects were observed for two seasons during which the risk of transmission of Lyme disease was high. The primary end point was the number of new clinically and serologically confirmed cases of Lyme disease. RESULTS: The efficacy of the vaccine was 68 percent in the first year of the study in the entire population and 92 percent in the second year among the 3745 subjects who received the third injection. The vaccine was well tolerated. There was a higher incidence of mild, self-limited local and systemic reactions in the vaccine group, but only during the seven days after vaccination. There was no significant increase in the frequency of arthritis or neurologic events in vaccine recipients. CONCLUSIONS: In this study, OspA vaccine was safe and effective in the prevention of Lyme disease.

Adolescent↗
PubMed1998

The consequences of overdiagnosis and overtreatment of Lyme disease: an observational study.

BACKGROUND: The adverse consequences associated with overdiagnosis and overtreatment of Lyme disease, although previously recognized, have received inadequate attention. OBJECTIVE: To determine the use of health services and occurrence of treatment-related illness, disability, and distress among patients in whom Lyme disease is inappropriately diagnosed or treated. DESIGN: Observational cohort study. SETTING: University-based Lyme disease clinic. PARTICIPANTS: 209 patients with a presumptive diagnosis of Lyme disease previously assigned by referring physicians, the patients themselves, or both. MEASUREMENTS: Self-reported data, review of medical records, and standardized instruments were used to determine 1) use of health services in terms of number of outpatient visits, number of physicians seen, types of serologic tests, and days of antibiotic treatment; 2) occurrence of antibiotic-related adverse events; and 3) levels of disability, depression, and stress. RESULTS: Of the 209 patients, 44 (21%) met criteria for active Lyme disease, 40 (19%) had previous but not active Lyme disease, and 125 (60%) had no evidence of current or previous infection. In general, patients with active Lyme disease (who were not the focus of this study) had good outcomes. Patients with previous Lyme disease and patients with no evidence of Lyme disease used considerable health resources (median number of office visits, 11 and 7; median number of serologic tests, 4 and 4; and median days of antibiotic treatment, 75 and 42), had frequent minor adverse drug events (53% and 55%), reported significant disability (proportion of symptomatic days during which normal activities could not be performed, 16% and 18%), and had high rates of depression (38% and 42%) and stress (52% and 45%). CONCLUSIONS: Overdiagnosis and overtreatment of Lyme disease are associated with inappropriate use of health services, avoidable treatment-related illness, and substantial disability and distress.

Adult↗
PubMed1998

Surgery for intestinal graft-versus-host disease: report of two cases.

PURPOSE: With allogeneic bone marrow transplantation becoming increasingly common, intestinal graft-versus-host disease often is seen within specialized transplant units. Surgeons are involved infrequently in the management of such patients, and yet occasionally are called upon to operate on critically ill patients with refractory disease. This article reviews the salient features of this condition and discusses possible indications for surgery. METHOD: Two cases of intestinal graft-versus-host disease that required laparotomy are presented. RESULTS: A 24-year-old male with severe, unremitting, acute intestinal graft-versus-host disease underwent small-bowel and large-bowel resections for massive bleeding. A 35-year-old male with recurrent symptoms of small-bowel obstruction after allogeneic bone marrow transplantation underwent small-bowel resection and multiple strictureplasties for chronic intestinal graft-versus-host disease. CONCLUSION: Surgery can be performed for complications of intestinal graft-versus-host disease not responding to medical therapy, with successful outcome.

Adult↗
PubMed1998

Glucose intolerance, physical signs of peripheral artery disease, and risk of cardiovascular events: the Framingham Study.

BACKGROUND: Diabetes and peripheral artery disease (PAD) are acknowledged hallmarks of development of atherosclerotic cardiovascular disease (CVD). The prognostic implications of physical indicators of PAD, compared with and in conjunction with glucose intolerance based on population based data, are not well documented. METHODS AND RESULTS: The influence of carotid and femoral bruits and nonpalpable pedal pulses, with and without glucose intolerance, on development of coronary disease (CHD), congestive heart failure (CHF), and stroke (CVA) was investigated in a cohort of 1672 men and 2264 women ages 47 to 99 years participating in the Framingham Study. Cross-sectional pooling yielded 29,063 2-year person-examination units based on the sample of whom 440 men and 484 women had glucose intolerance develop. Over the 26 years of follow-up, 210 men and 199 women had 1 or more of the specified CVD events. Logistic regression analysis was used to estimate age-adjusted odds ratios comparing incidence of CVD events in subjects with glucose intolerance, signs of PAD, or both conditions with those with neither condition. Glucose intolerance was associated with a 2-fold excess occurrence of physical signs of PAD (P< .01 ). Femoral and carotid bruits were generally associated with greater increased risk of CHD, CHF, and CVA than was glucose intolerance alone. Particularly in women, the concomitant presence of bruits augmented the CVD risk of glucose intolerance. Nonpalpable pedal pulses were a stronger risk factor for CVD end points than glucose intolerance; particularly in men and in both sexes, those with both conditions were at substantially greater risk of CVD events than those with either alone. CONCLUSIONS: Physical findings of PAD appear to signify a compromised arterial circulation to the heart and brain as well as the limbs in persons with glucose intolerance. Persons with the combination are candidates at high risk for CHD, CHF, and CVA.

Aged↗
PubMed1998

Antinuclear antibody testing in systemic autoimmune disease.

This article discusses the use and interpretation of antinuclear antibody (ANA) testing in connective tissue diseases. Methods of ANA detection are discussed and analyzed in detail as is the role of ANAs in systemic lupus, scleroderma, and polymyositis, connective tissue diseases with prominent pulmonary involvement.

Antibodies, Antinuclear↗
PubMed1998

The ecological validity of tests of executive function.

Ninety-two mixed etiology neurological patients and 216 control participants were assessed on a range of neuropsychological tests, including 10 neuropsychological measures of executive function derived from 6 different tests. People who knew the patients well (relatives or carers) completed a questionnaire about the patient's dysexecutive problems in everyday life, and this paper reports the extent to which the tests predicted the patients' everyday life problems. All of the tests were significantly predictive of at least some of the behavioral and cognitive deficits reported by patients' carers. However, factor analysis of the patients' dysexecutive symptoms suggested a fractionation of the dysexecutive syndrome, with neuropsychological tests loading differentially on 3 underlying cognitive factors (Inhibition, Intentionality, and Executive Memory), supporting the conclusions that different tests measure different cognitive processes, and that there may be limits to the fractionation of the executive system.

Adult↗
PubMed1998

Prothrombotic changes in children with sickle cell disease: relationships to cerebrovascular disease and transfusion.

Vascular occlusion has a central role in the pathophysiology of sickle cell disease (SCD) and, although there is little evidence that thrombosis alone is responsible, patients with sickle cell disease are known to have an ill-defined but increased thrombotic risk. The most serious complication of this in childhood is stroke which occurs in 7-10% of children and a further 14% have asymptomatic cerebrovascular disease (CVD) on imaging. We have performed a comprehensive profile of coagulation inhibitors and markers of thrombin generation in 96 children (83 nontransfused [NTx] and 13 transfused [Tx]) with steady-state SCD and 18 healthy sibling controls. The levels of protein S (free and total) and heparin cofactor II were reduced in both the NTx and Tx groups compared to controls and protein C and APC resistance ratios were reduced in the NTx group only. Antithrombin levels were not different from controls. Thrombin-antithrombin complexes and prothrombin fragment F1+2 were increased in both patient groups. In the NTx subgroups with or without CVD there were no differences for any of the parameters measured except for lower haemoglobin levels and higher white cell counts in those with asymptomatic CVD. We conclude that children with SCD have a reduction in levels of the majority of the coagulation inhibitors and increased thrombin generation in the steady-state and these are only partially reversed by transfusion. However, these abnormalities do not appear to play a primary role in the development of cerebrovascular disease.

Activated Protein C Resistance↗
PubMed1998

Prediction of resectability of pancreatic malignancy by computed tomography.

BACKGROUND: The accuracy of computed tomography (CT) in predicting resectability of pancreatic malignancy has been questioned recently and alternative methods have been recommended. METHODS: To determine the accuracy of CT for predicting resectability and its influence on survival, a standard protocol for performing CT and reporting the results was developed and then compared retrospectively with the ability of one surgeon to perform a resection during 1989-1994. Postoperative survival was determined. RESULTS: Of 88 consecutive patients 35 (40 per cent) had CT-resectable disease and 53 (60 per cent) had CT-irresectable disease. Twenty-one patients were excluded because of advanced disease or poor performance status. Of the remaining 67 patients, 47 (70 per cent) had pancreatic ductal adenocarcinoma and 20 (30 per cent) had ampullary adenocarcinoma, of whom 32 had a resection, 32 had a palliative bypass and three had only a staging laparoscopy. The sensitivity and specificity for computed tomographic prediction of resectability were 72 and 80 per cent respectively. The positive predictive value was 77 per cent and the negative predictive value 76 per cent. There were seven false-positive and nine false-negative findings. Survival was more dependent on whether or not resection was performed than on computed tomographic predictability of resection. CONCLUSION: CT was reasonably accurate in predicting resectability but cannot be relied on entirely, requiring an improvement in staging methods for pancreatic malignancy.

Adenocarcinoma↗
PubMed1998

Molecular characterization and expression of cloned human galanin receptors GALR2 and GALR3.

Galanin is a 29- or 30-amino acid peptide with wide-ranging effects on hormone release, feeding behavior, smooth muscle contractility, and somatosensory neuronal function. Three distinct galanin receptor (GALR) subtypes, designated GALR1, 2, and 3, have been cloned from the rat. We report here the cloning of the human GALR2 and GALR3 genes, an initial characterization of their pharmacology with respect to radioligand binding and signal transduction pathways, and a profile of their expression in brain and peripheral tissues. Human GALR2 and GALR3 show, respectively, 92 and 89% amino acid sequence identity with their rat homologues. Radioligand binding studies with 125I-galanin show that recombinant human GALR2 binds with high affinity to human galanin (K(D) = 0.3 nM). Human GALR3 binds galanin with less affinity (IC50 of 12 nM for porcine galanin and 75 nM for human galanin). Human GALR2 was shown to couple to phospholipase C and elevation of intracellular calcium levels as assessed by aequorin luminescence in HEK-293 cells and by Xenopus melanophore pigment aggregation and dispersion assays, in contrast to human GALR1 and human GALR3, which signal predominantly through inhibition of adenylate cyclase. GALR2 mRNA shows a wide distribution in the brain (mammillary nuclei, dentate gyrus, cingulate gyrus, and posterior hypothalamic, supraoptic, and arcuate nuclei), and restricted peripheral tissue distribution with highest mRNA levels detected in human small intestine. In comparison, whereas GALR3 mRNA was expressed in many areas of the rat brain, there was abundant expression in the primary olfactory cortex, olfactory tubercle, the islands of Calleja, the hippocampal CA regions of Ammon's horn, and the dentate gyrus. GALR3 mRNA was highly expressed in human testis and was detectable in adrenal gland and pancreas. The genes for human GALR2 and 3 were localized to chromosomes 17q25 and 22q12.2-13.1, respectively.

Amino Acid Sequence↗
PubMed1998

Escherichia coli O157 serology: false-positive ELISA results caused by human antibodies binding to bovine serum albumin.

An analysis of farm workers and rural dwellers for serum antibodies to the lipopolysaccharide (LPS) of Escherichia coli O157 detected sera with antibodies binding to bovine serum albumin (BSA) by ELISA. These antibodies were not specific for BSA when examined by immunoblotting, and the ELISA values were reduced to a background level when plates were blocked with normal rabbit serum.

Animals↗
PubMed1998

Facial contour reconstruction in localised lipodystrophy using free radial forearm adipofascial flaps.

Unilateral facial contour deformities in two patients with localised lipodystrophies were reconstructed with free radial forearm adipofascial flaps. At follow-up of 5 and 4 years there is no significant downward gravitation, and the flaps have maintained their integrity and bulk. Both the patients have had significant improvement in their self-consciousness of appearance. Since the donor site was closed primarily, a linear forearm scar remains the only donor site morbidity.

Adipose Tissue↗
PubMed1998

Visual acuity and its relationship to early growth, eye disease, and aging in north Hertfordshire.

We investigated the relationship between visual acuity, early growth and eye disease in a retrospective cohort study of 700 individuals in North Hertfordshire. Records of birth weight and weight at one year were used to determine early growth. We measured visual acuity and age-related eye diseases using standard instruments in those same individuals (now aged 63 to 73). Visual acuity below the legal threshold for driving in the UK (6/11 or poorer) was present in 13% of subjects. There was no clear association between birth weight or weight at one year and visual acuity. Vision impairment was found to be associated with refractive error, cataract, age-related maculopathy, and elevated macular threshold. After controlling for the effects of eye disease, increasing age remained a significant predictor of poorer visual acuity.

Aged↗
PubMed1998

The treatment of oropharyngeal candidiasis in HIV-infected patients with oral amphotericin B suspension.

Oropharyngeal candidiasis (OPC) is the most frequent opportunistic infection associated with HIV infection. Therapies such as topical clotrimazole and nystatin, as well as oral azoles, which had previously been effective prior to the advent of HIV, are increasingly only partially effective in OPC in HIV infection. The effectiveness of oral amphotericin B suspension for OPC is described in 17 HIV-infected patients whose response to other therapies had been unsatisfactory. Three patients yielded isolates of Candida albicans with a minimum inhibitory concentration (MIC) to fluconazole of >/=16 microg/mL. Eleven patients received amphotericin B suspension monotherapy. Of the 17 patients, the symptoms of six resolved entirely, seven patients partially responded, and four failed therapy. These data suggest that amphotericin B suspension may be a useful additional therapy for OPC in HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1998

Lyme disease.

A record number of cases of Lyme disease was reported in the United States in 1996. The steady increase in Lyme disease cases coincides with a growth in deer populations in endemic regions. Application of careful epidemiologic principles have led to the identification of two new pathogens that produce syndromes closely related to Lyme disease. Coinfection with Borrelia burgdorferi and the agent of human granulocytic ehrlichiosis have been documented. Coinfection with multiple organisms may alter the clinical course of Lyme disease. Better understanding of the pathogenesis of neuroborreliosis has provided clues into mechanisms responsible for persistent symptoms and will serve as a foundation for the design and implementation of appropriate therapeutic recommendations. A safe vaccine for the prevention of Lyme disease in humans has been developed, and preliminary reports from large clinical vaccine efficacy trials look promising.

Animals↗