Search PubMed⌕ Search

Biomedical subjects

J Hughes

Publications and source records attributed to J Hughes.

At least 217 records · Page 12Linked to original sources

Gabapentin (neurontin) and S-(+)-3-isobutylgaba represent a novel class of selective antihyperalgesic agents.

1. Gabapentin (neurontin) is a novel antiepileptic agent that binds to the alpha 2 delta subunit of voltage-dependent calcium channels. The only other compound known to possess affinity for this recognition site is the (S)-(+)-enantiomer of 3-isobutylgaba. However, the corresponding (R)-(-)-enantiomer is 10 fold weaker. The present study evaluates the activity of gabapentin and the two enantiomers of 3-isobutylgaba in formalin and carrageenan-induced inflammatory pain models. 2. In the rat formalin test, S-(+)-3-isobutylgaba (1-100 mg kg-1) and gabapentin (10-300 mg kg-1) dose-dependently inhibited the late phase of the nociceptive response with respective minimum effective doses (MED) of 10 and 30 mg kg-1, s.c. This antihyperalgesic action of gabapentin was insensitive to naloxone (0.1-10.0 mg kg-1, s.c.). In contrast, the R-(-)-enantiomer of 3-isobutylgaba (1-100 mg kg-1) produced a modest inhibition of the late phase at the highest dose of 100 mg kg-1. However, none of the compounds showed any effect during the early phase of the response. 3. The s.c. administration of either S-(+)-3-isobutylgaba (1-30 mg kg-1) or gabapentin (10-100 mg kg-1), after the development of peak carrageenan-induced thermal hyperalgesia, dose-dependently antagonized the maintenance of this response with MED of 3 and 30 mg kg-1, respectively. Similar administration of the two compounds also blocked maintenance of carrageenan-induced mechanical hyperalgesia with MED of 3 and 10 mg kg-1, respectively. In contrast, R-(-)-3-isobutylgaba failed to show any effect in the two hyperalgesia models. 4. The intrathecal administration of gabapentin dose-dependently (1-100 micrograms/animal) blocked carrageenan-induced mechanical hyperalgesia. In contrast, administration of similar doses of gabapentin into the inflamed paw was ineffective at blocking this response. 5. Unlike morphine, the repeated administration of gabapentin (100 mg kg-1 at start and culminating to 400 mg kg-1) over 6 days did not lead to the induction of tolerance to its antihyperalgesic action in the formalin test. Furthermore, the morphine tolerance did not cross generalize to gabapentin. The s.c. administration of gabapentin (10-300 mg kg-1), R-(-) (3-100 mg kg-1) or S-(+)-3-isobutylgaba (3-100 mg kg-1) failed to inhibit gastrointestinal motility, as measured by the charcoal meal test in the rat. Moreover, the three compounds (1-100 mg kg-1, s.c.) did not generalize to the morphine discriminative stimulus. Gabapentin (30-300 mg kg-1) and S-(+)-isobutylgaba (1-100 mg kg-1) showed sedative/ataxic properties only at the highest dose tested in the rota-rod apparatus. 6. Gabapentin (30-300 mg kg-1, s.c.) failed to show an antinociceptive action in transient pain models. It is concluded that gabapentin represents a novel class of antihyperalgesic agents.

Acetates↗

Psychometric evaluation of a questionnaire to document side-effects of chemotherapy.

This paper reports the psychometric testing of the Worthing Chemotherapy Questionnaire (WCQ). The WCQ is a patient self-report instrument to document side-effects of chemotherapy. Literature review of relevant studies shows that psychometric testing of similar instruments is rarely rigorous. Content validity for the WCQ was established in five ways: literature review, Delphi review among oncology staff, pre-pilot unstructured interviews, pilot study and amendment of the instrument and items for spontaneous reporting of problems on the questionnaire. A three-stage approach to construct validity was used. The hypothesis adopted was that as certain cytotoxic agents cause stomatitis, incidence and severity of stomatitis will decrease following cessation of treatment. Stage 1: factor analysis confirmed the presence of a sole factor, with an eigenvalue of 5.3, for mouth problems which explained 65.5% of the variance. Stage 2: the hypothesis was confirmed using research findings. Stage 3: the Wilcoxon test showed highly significant results for during and post chemotherapy stomatitis scores. Reliability of the questionnaire was assessed using the test-retest method. Weighted kappa was chosen as the test statistic. A median value of wk = 0.87 was obtained. The results indicate that the WCQ is a reliable and valid instrument.

Antineoplastic Agents↗

Cell salvage auto transfusion in total knee replacement surgery.

We conducted a prospective, randomized study to assess the impact of cell salvage, auto transfusion on the requirements for allogeneic blood for patients undergoing a total knee replacement (TKR). One hundred consecutive TKR patients were randomly allocated to receive either autologous blood (using cell salvage) or an allogeneic blood transfusion as necessary. Patients allocated to the autologous group were rescued with allogeneic blood if the postoperative haemoglobin fell below 9 g dL-1. Forty-two (84%) of 50 patients in the autologous group required no supplementary blood transfusion. Forty (80%) of 50 patients allocated to receive allogeneic blood required transfusion. There were no detrimental effects of autologous blood transfusion. We conclude that autologous blood transfusion, using the cell saver system, is a safe and effective method of reducing the need for allogeneic blood transfusion and, in doing so, reduces the risk of transmission of infections associated with allogeneic blood transfusion, whilst decreasing demand on precious allogeneic blood reserves.

Aged↗

A randomized controlled trial of sedation in the critically ill.

A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi-squared P < 0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/ distressed) was significantly greater in the midazolam group (Chi-squared P < 0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.

Administration, Oral↗

Evidence for the view that temporospatial integration in vision is temporally anisotropic.

In two experiments low-pass and high-pass spatially filtered versions of a base image were prepared and the effect of the order of delivery of sequences of filtered and base images investigated. A task that required subjects to discriminate 120 ms presentations of a full-bandwidth base image and degraded sequences that contained sets of three different spatially filtered versions, or mixtures of spatially filtered and full-bandwidth versions of the image, were used. Each set of images used in the degraded sequences was presented either so that within the 120 ms presentation window the spatial content swept from low to high spatial frequencies or from high to low. In experiment 1 twenty subjects discriminated between a base image and degraded sequences of an urban scene. Results showed both a significant overall effect of image order, with low-to-high spatial-frequency information delivery being mistaken more often for the full-bandwidth presentation than high-to-low, and that different sets of degraded image sequences varied significantly in the frequency with which they were mistaken for the full-bandwidth presentation. In experiment 2 a base and filtered versions of a human face were used in an identical task with twenty different subjects and a very similar pattern of significant results was obtained, although imposed on a lower overall error frequency than that obtained in experiment 1. It was concluded that the results of both experiments provide evidence for an anisotropic temporospatial integration mechanism in which availability of spatial information in a low-to-high spatial-frequency sequence results in more efficient integration than a high-to-low.

Adolescent↗

A comparison of the effects of sacred and secular music on elderly people.

Two kinds of music, sacred and secular, were played to elderly participants and rated by them on various aspects of evoked feelings. Additionally, pre- and posttest batteries of questionnaires were administered to measure the spirituality and ego integrity of the listeners. Statistical analyses of the findings failed to reveal significant effects on the spirituality of the participants, although the two kinds of music were rated differently. When results for all the music were combined, a significant and positive correlation was found between the spirituality scores of the listeners and the ratings of both kinds of music for reverence or spirituality. Most participants found the selections restful and evocative for memories and thoughtfulness. Music of the type used in this study may have potential value as an accompaniment for techniques such as life review and relaxation therapy.

Adaptation, Psychological↗

Community-acquired notifiable infectious diseases in a pediatric hospital: effect on infection control work load.

In a study of the impact of notifiable communicable disease admissions on infection control work load, we found notifiable disease cases to be responsible for less than 10% of admissions but 27% of infection control ward visits and to require extensive community liaison. Measures of work load based on nosocomial infections alone will underestimate infection control activity considerably.

Child↗

Comparative analysis of the polycystic kidney disease 1 (PKD1) gene reveals an integral membrane glycoprotein with multiple evolutionary conserved domains.

PKD1 is the major locus of the common genetic disorder autosomal dominant polycystic kidney disease (ADPKD). Analysis of the predicted protein sequence of the human PKD1 gene, polycystin, shows a large molecule with a unique arrangement of extracellular domains and multiple putative transmembrane regions. The precise function of polycystin remains unclear with a paucity of mutations to define key structural and functional domains. To refine the structure of this protein we have cloned the genomic region encoding the Fugu PKD1 gene. Fugu PKD1 spans 36 kb of genomic DNA and has greater complexity with 54 exons compared with 46 in man. Comparative analysis of the predicted protein sequences shows a lower level of homology than in similar studies with identity of 40 and 59% similarity. However key structural motifs including leucine rich repeats (LRR), a C-type lectin and LDL-A like domains and 16 PKD repeats are maintained. A region of homology with the sea urchin REJ protein was also confirmed in Fugu but found to extend over 1000 amino acids. Several highly conserved intra- and extra-cellular regions, with no known sequence homologies, that are likely to be of functional importance were detected. The likely structure of the membrane associated region has been refined with similarity to the PKD2 protein and voltage gated Ca2+ and Na+ channels highlighted over part of this area. The overall protein structure has therefore been clarified and this comparative analysis derived structure will form the basis for the functional study of polycystin and its individual domains.

Amino Acid Sequence↗

Longitudinal analysis of quantitative virologic measures in human immunodeficiency virus-infected subjects with > or = 400 CD4 lymphocytes: implications for applying measurements to individual patients. National Institute of Allergy and Infectious Diseases AIDS Vaccine Evaluation Group.

The natural variability of quantitative virologic measures among human immunodeficiency virus (HIV) type 1-infected persons was prospectively studied in 29 untreated persons with >600 CD4 cells/microL and in 15 persons receiving zidovudine monotherapy who had 400-550 CD4 cells/microL at study entry. Cell- and plasma-associated infectious HIV-1, provirus, and virion RNA were determined monthly as were numbers of CD4 and CD8 cells. HIV-1 replication varied widely among subjects with similar CD4 cell counts. The within-individual variability was significantly less than the variability between subjects for all virologic measures. Plasma virion HIV-1 RNA levels had the least variability. A mathematical model was devised to assess whether a potential therapeutic intervention significantly alters peripheral HIV-1 load. The model indicated that three measurements of plasma RNA would be outside the 95th percentile for the expected change in an individual due to natural variability. This approach can be used to accurately assess a therapeutic intervention among persons with low plasma HIV-1 titers.

Adult↗

Studies on stannous fluoride toothpaste and gel (1). Antimicrobial properties and staining potential in vitro.

Stannous fluoride (SF) in a toothpaste vehicle has the potential to provide anticaries and plaque inhibitory benefits through the fluoride and antimicrobial stannous moieties respectively. Dental staining, however, can occur by precipitation of dietary chromogens onto the tooth surface by stannous ions. These studies in vitro compare the antimicrobial profile and propensity to cause tea staining of a number of stannous fluoride formulations. The formulations used were 2 SF toothpaste products (SF1, SF2), 2 experimental SF plus stannous pyrophosphate toothpastes (SFSP1, SFSP2), a SF gel (G) and a NaF toothpaste (C). Maximum inhibitory dilution values against a range of oral bacteria were determined by agar dilution. Tea staining was measured spectrophotometrically on saliva coated clear acrylic blocks exposed to slurries of the paste or gel. All formulations showed antimicrobial activity with the order of greatest activity downwards being C, SF2, SF1, SFSP1, SFSP2 and G. Tea staining at 10 exposures was in the following descending order of optical density SFSP1, SFSP2, G. C, SF1, SF2, water control. The antimicrobial profile of G was similar to that of SF, whereas that of the other formulations were varied but similar to a detergent profile. The difference in staining suggested considerable variation in availability of stannous ions in the formulations. However, the propensity for stannous ions to stain must be balanced against the stain removal propensity of the contained detergents in the toothpaste formulations. In conclusion, the variation in antimicrobial activity and more particularly staining activity of the formulations suggest the products will vary in activity in vivo.

Anti-Infective Agents, Local↗

Bridging the chasm: incorporating the medically compromised patient into psychiatric practice.

1. In response to health care reform, psychiatric nursing has identified an expanded role that includes providing care to patients with complex health problems. 2. Conceptual changes of role responsibilities and time commitments to individual and milieu care are vital in supporting a change in the traditional psychiatric milieu. 3. Acknowledging and helping staff accept the unpredictability of certain medical conditions is key to success in providing quality integrated care to the medically compromised psychiatric patient.

Attitude of Health Personnel↗

Using a multidisciplinary automated discharge summary process to improve information management across the system.

We developed and implemented an automated discharge summary process in a regional integrated managed health system. This multidisciplinary effort was initiated to correct deficits in patients' medical record documentation involving discharge instructions, follow-up care, discharge medications, and patient education. The results of our team effort included an automated summary that compiles data entered via computer pathways during a patient's hospitalization. All information regarding admission medications, patient education, follow-up care, referral at discharge activities, diagnosis, and other pertinent medical events are formulated into the discharge summary, discharge orders, patient discharge instructions, and transfer information as applicable. This communication process has tremendously enhanced information management across the system and helps us maintain complete and thorough documentation in patient records.

Delivery of Health Care, Integrated↗

Neutrophil fate in experimental glomerular capillary injury in the rat. Emigration exceeds in situ clearance by apoptosis.

Neutrophils (PMNs) and their toxic contents can injure glomeruli, but to date their fate in glomerulonephritis has been unknown. We studied glomerulonephritis induced in rats by formation of concanavalin A (Con A)/anti-Con A immune complexes on glomerular endothelial cells. PMN infiltration, which was almost exclusively confined to the lumen of glomerular capillaries, was transient, peaking at 4 hours, with only 9.0 +/- 4.1% (mean +/- SEM) of the maximum remaining at 24 hours. There was clear evidence of PMN apoptosis leading to phagocytosis in situ by intraluminal macrophages. However, the kinetics of leukocyte infiltration and PMN apoptosis, the preferential location at 24 hours of apoptotic PMNs within occluded capillary loops, and tracking of radiolabeled PMNs all indicated that in situ phagocytic clearance after apoptosis was the fate of a minority of PMNs, amounting to no more than one-fifth of the peak infiltrating load. Instead, the majority of infiltrating PMNs (72.9 +/- 3.1%) had emigrated from inflamed glomeruli by 24 hours, apparently returning to the circulation. We conclude that PMN emigration from inflamed glomeruli is a hitherto unrecognized mechanism for regulation of PMN-mediated glomerular injury.

Animals↗

Corneal astigmatism in preschool Native Americans.

BACKGROUND: Native Americans tend to have high amounts of corneal and refractive with-the-rule astigmatism. This condition is reported to be of recent onset. Astigmatism has been shown to be prevalent in preschool-age children but, because of the process of emmetropization, this condition generally disappears by school age. Navajo children have been shown, however, to enter first grade with high mean amounts and high prevalence of with-the-rule astigmatism. This study was undertaken to ascertain whether with-the-rule astigmatism decreased in Navajo preschool children as they grew older. METHODS: Cross-sectional keratometric data were gathered on 250 preschool Navajo children from three states in the four corners district of the Navajo nation. RESULTS: High mean amounts of with-the-rule corneal astigmatism are prevalent at each age represented in this study. Girls have steeper corneas and more astigmatism than boys. Although the steepness of the corneal curve generally decreases slightly but significantly with age, the calculated astigmatism does not. The steepness of corneas also appears to vary by geographical area of residence within the Navajo nation. CONCLUSIONS: Emmetropization, with respect to the disappearance of astigmatism, does not appear to take place among the Navajo as it does in either Caucasian or Asian preschool-age children.

Astigmatism↗

EEG spectral analysis of the neuroprotective kappa opioids enadoline and PD117302.

The present study characterized the electroencephalographic (EEG) effects of the neuroprotective kappa opioids enadoline and PD117302 in conscious, freely moving rats with the use of computer-assisted spectral analysis (CASA). Enadoline (25-100 microg/kg) or PD117302 (1.25-5.0 mg/kg) was administered intravenously to rats implanted with cortical EEG electrodes. Although both drugs produced an immediate, mild sedation, there were no signs of head-weaving or ataxia, and there was little visual evidence of opioid-like EEG slow-wave bursts or seizures. Both drugs produced only modest increases in total EEG power that were not dose dependent. In contrast, CASA revealed significant dose-dependent frequency shifts in relative power distributions, thereby identifying distinct kappa opioid alterations in awake EEG activity; EEG power decreased in the 0- to 4-Hz frequency band with concomitant increases in power measured in the 4- to 8-Hz frequency range. The kappa opioids produced a dose-dependent consolidation of the EEG waveform centered about a peak frequency of 5.0 Hz (for enadoline) or 4.8 Hz (for PD117302) and a significant shift in the mean EEG frequency from 6.6 Hz (predrug) to 6.2 Hz (postdrug). Further CASA revealed significant postdrug decreases in the edge frequency, mobility and complexity of the EEG. Both drugs produced moderate increases in the latency to slow-wave sleep (SWS). Overall, enadoline (ED50 = 18 microg/kg) was approximately 94 times more potent than PD117302 (ED50 = 1690 microg/kg) in producing the kappa EEG profile. Because the kappa-induced EEG changes were stereospecific for the (-)-enantiomers and inhibited by norbinaltorphimine (nor-BNI), the EEG "fingerprint" described in this study could be attributed to specific activation of brain kappa opioid receptors.

Animals↗