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Biomedical subjects

J Hunter

Publications and source records attributed to J Hunter.

At least 55 records · Page 3Linked to original sources
PubMed2000

The long-term effects of non-steroidal anti-inflammatory drugs in osteoarthritis of the knee: a randomized placebo-controlled trial.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat osteoarthritis (OA), though their long-term efficacy is uncertain. We report a comparison of the symptomatic responses to therapy with tiaprofenic acid, indomethacin and placebo over 5 yr. METHODS: A parallel-group, randomized, single-blind trial of patients with knee OA recruited 812 patients from 20 centres; 307 patients received tiaprofenic acid (300 mg b.d.), 202 indomethacin (25 mg t.d.s.) and 303 matching placebo for up to 5 yr. At the end of the parallel-group study, patients receiving tiaprofenic acid or placebo entered a 4-week blinded cross-over study of tiaprofenic acid or placebo, both given for 2 weeks. Assessments were at baseline, 4 weeks, then at 6-month intervals for up to 5 yr in the parallel group study and at 2-week intervals in the cross-over study. They comprised pain scores, duration of morning stiffness, patients' global assessments, paracetamol consumption, adverse reactions, withdrawals and functional outcomes. RESULTS: There were significant falls in overall pain scores in patients receiving NSAIDs compared with placebo at 4 weeks in the parallel-group phase. Thereafter there were no advantages favouring active therapy. In the cross-over phase, pain scores were significantly lower in patients receiving tiaprofenic acid than placebo. Patients who had been receiving long-term tiaprofenic acid showed significant rises in their pain scores when receiving placebo therapy and vice versa. Adverse events were reported by 61% of patients receiving tiaprofenic acid, 63% on indomethacin and 51% on placebo. Potentially severe side-effects were rare; for example, there were only three cases of gastrointestinal bleeding on NSAIDs. The pattern of withdrawal was similar in patients taking NSAIDs and placebo in the parallel-group study; at 48 weeks 53% of the patients remained on tiaprofenic acid, 50% on indomethacin and 54% on placebo. CONCLUSIONS: NSAIDs significantly reduce overall pain over 4 weeks. This short-term responsiveness is retained, and even after several years of therapy with tiaprofenic acid pain scores increased over 2 weeks when it was changed to placebo. Our results do not show long-term benefits from the use of NSAIDs in OA and the majority of patients had persisting pain and disability despite therapy.

Adult↗
PubMed2000

Thoracoabdominal asynchrony failed to grade airway obstructions in foals.

Respiratory inductive plethysmography (RIP) can be used to obtain a valid measure of tidal volume in humans. This device also compares the contributions to ventilation of the thorax and abdomen. Although thoracoabdominal asynchrony is a prominent clinical feature for patients with airway obstruction, the accuracy of the RIP device to assess the severity of obstruction is unclear. This study analyzes how well RIP variables reflect the degree of a fixed external inspiratory plus expiratory resistive load in foals. Foals were employed because the species and age group are commonly afflicted with respiratory disease. Eight conscious, sedated (xylazine 1.25 mg/kg body wt) foals were subjected to randomly ordered resistive loads at the airway opening and, on a separate day, to histamine aerosol challenge. During resistive loading, phase angle changed significantly, as did phase relation (P < or = 0.05). However, no significant correlation was found between the degree of change in resistive load and the degree to which phase angle or relation was altered (r(s) = 0.41 and 0.25, respectively). In addition, neither phase angle nor relation changed significantly with histamine challenge. We conclude that, although RIP variables changed markedly with fixed upper airway resistive loading, the degree to which they changed was erratic and therefore not useful for grading these obstructions. Furthermore, RIP variables were insensitive measures of histamine-induced bronchoconstriction.

Abdomen↗
PubMed2000

Thoracoabdominal compression and respiratory system compliance in HIV-infected infants.

The thoracoabdominal compression technique (TAC) is used to measure expiratory flow in infants. We investigated whether TAC caused a change in total thoracic compliance (Crs), resistance (Rrs), and respiratory system time constant (Trs). We studied 41 infants (mean age, 12.4 mo; SD, 7.5) from five centers studying longitudinal lung and cardiovascular function of infants from HIV-infected mothers. We measured Crs, Rrs, and Trs before and after TAC. Changes in Crs, Rrs, and Trs after TAC were not dependent on the length of time since TAC. Crs and Trs were reduced after TAC, p = 0.013 and p = 0.003, respectively, whereas Rrs did not change. When compared with uninfected infants, HIV-infected infants had a larger post-pre TAC percent decline in Crs (p = 0.003) and a post-pre TAC rise in mean Rrs (p = 0.03). These differences remained significant after adjusting for sex and age. When performing infant pulmonary function testing, TAC itself produces a temporary decrease in Crs and Trs that is more significant in infants at risk for abnormal lung volume or compliance. Therefore, the sequence of performing the infant lung function parameters should be the same each time the testing is repeated with TAC as the last parameter tested at each testing session.

Abdomen↗
PubMed2000

Nurse practitioner intervention to improve the use of metered-dose inhalers by children with asthma.

Metered-dose inhalers (MDIs) have become a mainstay of maintenance therapy for various allergic and respiratory conditions. When used correctly, MDIs are as effective as nebulized medications. Patients use MDIs incorrectly in many cases because of poor instruction and lack of spacer devices. Nurses and physicians often teach the technique improperly. Nurse practitioners can have a positive impact in improving care through better patient and staff teaching and the use of spacer devices with MDIs.

Administration, Inhalation↗
PubMed2000

Analysis of edible oil processing options for the BIO-Plex advanced life support system.

Edible oil is a critical component of the proposed plant-based Advanced Life Support (ALS) diet. Soybean, peanut, and single-cell oil are the oil source options to date. In terrestrial manufacture, oil is ordinarily extracted with hexane, an organic solvent. However, exposed solvents are not permitted in the spacecraft environment or in enclosed human tests by National Aeronautics and Space Administration due to their potential danger and handling difficulty. As a result, alternative oil-processing methods will need to be utilized. Preparation and recovery options include traditional dehulling, crushing, conditioning, and flaking, extrusion, pressing, water extraction, and supercritical extraction. These processing options were evaluated on criteria appropriate to the Advanced Life Support System and BIO-Plex application including: product quality, product stability, waste production, risk, energy needs, labor requirements, utilization of nonrenewable resources, usefulness of by-products, and versatility and mass of equipment to determine the most appropriate ALS edible oil-processing operation.

Arachis↗
PubMed1999

Rhinoviruses replicate effectively at lower airway temperatures.

Rhinoviruses are epidemiologically connected to the majority of acute asthma exacerbations; however, their ability to infect and replicate in the lower airways is disputed. A frequent argument against this possibility involves the temperature preference for rhinovirus replication, generally accepted to be 33 degrees C, the temperature of the nasal passages. However, this argument is based on studies with a single rhinovirus serotype. In this study, differences in temperature preferences were evaluated between several serotypes and relative titers were determined than can be achieved at upper and lower airway temperatures. Rhinovirus serotypes 1b, 2, 7, 9, 14, 16, 41, and 70 were titrated in Ohio-HeLa cell cultures at either 33 degrees C or 37 degrees C. Possible selection by culture temperature was examined by continuous culture at 33 degrees C and 37 degrees C for 2-4 passages and subsequent titration at both temperatures. Finally, nasal aspirate samples derived from patients with wild-type rhinoviral common colds were cultured at 33 degrees C and 37 degrees C and RT-PCR was used to assess rhinovirus replication at each temperature. The majority of the serotypes and wild-type viruses replicated slightly better at 33 degrees C than at 37 degrees C. However, titers achieved after one or more replicative cycles at 37 degrees C were still high enough to initiate infection. Furthermore, in some instances equal or even better replication was observed at 37 degrees C. It is concluded that temperature preferences may vary between rhinoviruses and are not likely to be a prohibitive factor for infection of the lower airways.

HeLa Cells↗
PubMed1999

A new form of access for endo-organ surgery. The initial experience with percutaneous endoscopic gastrostomy.

BACKGROUND: Intraluminal gastric surgery provides a new treatment option for various disease processes. This study assesses the safety of a new large-diameter percutaneous endoscopic gastrostomy (PEG) for intraluminal surgery. METHODS: Investigators at six institutions were asked to complete a standard questionnaire to assess the difficulties associated with the assembly and introduction of the PEG, plus intraoperative and postoperative problems related to placement of the device. RESULTS: In terms of assembly; 1.9% of respondents reported difficulty obtaining complete vacuum of the balloon tip, and 3.8% had difficulty fitting the graduated dilator to the balloon-tipped cannula. Difficulties associated with introduction of the PEG included disengagement of the dilator from the balloon-tipped cannula (0%), extraction of the dilator-port assembly (0%), difficult PEG pullout (1.9%), abdominal wall bleeding (0%), and difficult PEG dilator separation (7.5%). Intraoperatively, 7.5% of respondents reported inadequate skin bolster fitting, 1.9% had CO(2) leakage into the peritoneal cavity, 0% had inadvertent PEG extraction, and 0% reported injury to the esophagus, colon, or small intestine. Postoperatively, there was a 9.4% rate of wound infection, a 1.9% rate of gastrocutaneous fistula, and a 1.9% rate of esophageal, colon, or small intestine injury. CONCLUSIONS: The large-diameter PEG is safe and effective for endo-organ surgery. Additional preventive measures for PEG site infection should be investigated.

Adult↗
PubMed1999

Rhinovirus identification by BglI digestion of picornavirus RT-PCR amplicons.

Rhinoviruses are the main cause of the common cold and precipitate the majority of asthma exacerbations. RT-PCR followed by internal probe hybridisation or Southern blotting, or nested PCRs are currently the most sensitive methods for their identification. However, none of the published techniques can differentiate satisfactorily rhinoviruses from other picornaviruses. Examination of the restriction maps of sequenced rhinoviruses, revealed a highly conserved BglI restriction site (GCCnnnnnGGC), located exactly in the middle of the 380-bp amplicon generated with the OL26-OL27 primer pair, which has been used extensively in the past to identify picornaviruses. Such a site was either not present, or positioned differently in other picornaviruses of known sequence. It was, therefore, considered that digestion of rhinovirus amplicons with this enzyme would result in two equal length fragments, generating a single 190-bp band in gel electrophoresis. In contrast, either one undigested 380-bp band or a double-band pattern would appear in amplicons from other picornaviruses. To test this hypothesis, Bgl digestions of OL26-OL27 amplicons from cultured and wild-type rhinoviruses, whose identity was confirmed by acid lability, as well as from echo, polio and coxsackie viruses were carried out. All rhinovirus samples were digested successfully generating single bands. Among the other picornaviruses, only 6.6% presented a single band pattern, while the rest were as predicted from the model. With a sensitivity of 100% and a specificity over 90%, the method described, which is rapid and remarkably easy to perform, can be used to distinguish rhinoviruses from other picornaviruses to a considerable extent.

Deoxyribonucleases, Type II Site-Specific↗
PubMed1999

Characterization of LMP polymorphism in homozygous typing cells and a random population.

Within the class II region of the MHC are several genes whose products are involved in processing antigen for HLA class I presentation. Two such genes, LMP2 and LMP7, encode products that are incorporated into a multicatalytic proteinase complex which serves as the major pathway for protein degradation for class I peptide presentation. Polymorphic residues have been identified in both LMP2 and LMP7. In this report, we describe an ARMS-PCR method to distinguish LMP7 alleles. We applied this method to characterize these alleles in addition to LMP2 alleles in 50 homozygous typing cells (HTC) as well as in a panel of 110 random individuals. Of the four possible combinations of LMP2 and LMP7, we observed three in the HTC population, while all four were observed in the random population. The frequencies at which allele combinations were observed were similar to that predicted by individual allele frequencies. We also analyzed the possibility of linkage disequilibrium of LMP2 and LMP7 alleles with TAP1, TAP2, and specific HLA class I alleles in both populations. From this data, there seems to be no apparent linkage disequilibrium and no indication that particular combinations of LMP2 and LMP7 have been maintained.

Cysteine Endopeptidases↗
PubMed1999

Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms.

We used a novel computerized decision-making task to compare the decision-making behavior of chronic amphetamine abusers, chronic opiate abusers, and patients with focal lesions of orbital prefrontal cortex (PFC) or dorsolateral/medial PFC. We also assessed the effects of reducing central 5-hydroxytryptamine (5-HT) activity using a tryptophan-depleting amino acid drink in normal volunteers. Chronic amphetamine abusers showed suboptimal decisions (correlated with years of abuse), and deliberated for significantly longer before making their choices. The opiate abusers exhibited only the second of these behavioral changes. Importantly, both sub-optimal choices and increased deliberation times were evident in the patients with damage to orbitofrontal PFC but not other sectors of PFC. Qualitatively, the performance of the subjects with lowered plasma tryptophan was similar to that associated with amphetamine abuse, consistent with recent reports of depleted 5-HT in the orbital regions of PFC of methamphetamine abusers. Overall, these data suggest that chronic amphetamine abusers show similar decision-making deficits to those seen after focal damage to orbitofrontal PFC. These deficits may reflect altered neuromodulation of the orbitofrontal PFC and interconnected limbic-striatal systems by both the ascending 5-HT and mesocortical dopamine (DA) projections.

Adult↗
PubMed1999

Understanding the unprotected sexual behaviors of gay, lesbian, and bisexual youths: an empirical test of the cognitive-environmental model.

The cognitive-environmental model (CEM; M. Fishbein et al., 1991) was used to understand the unprotected sexual behaviors of 156 gay, lesbian, and bisexual youths. Unprotected anal sex among the males was associated directly with poor protection skills (e.g., incorrect use of barrier methods, such as condoms), poor intentions to use barrier methods, and poor norms by sexual partners concerning barrier methods. Furthermore, the association between low self-efficacy and increasing unprotected anal sex was attributed to poor intentions. Direct associations of unprotected oral sex with poor intentions and poor partner norms also emerged, as did an indirect relation between unprotected oral sex and low self-efficacy via poor intentions. These last 3 findings were replicated when examining unprotected oral or vaginal-digital sex among the females. Relations among the CEM factors supported some CEM-theoretical propositions.

Adolescent↗
PubMed1999

The pharmacokinetics and safety profile of oral ganciclovir in combination with trimethoprim in HIV- and CMV-seropositive patients.

AIMS: We investigated the pharmacokinetics and safety profile of oral ganciclovir coadministered with trimethoprim in HIV-and CMV-seropositive patients. METHODS: In an open-label, randomized, 3-way crossover study, 12 adult males received oral ganciclovir 1000 mg every 8h, oral trimethoprim 200 mg once daily, or both drugs concomitantly in a sequence of three 7-day treatment periods. Pharmacokinetic parameters were determined and adverse events recorded for each treatment. RESULTS: The presence of trimethoprim significantly decreased CLr (12.9%, P=0.0068) and increased t1/2 (18.1%, P=0.0378) of ganciclovir. However, these changes are unlikely to be clinically meaningful. There were no statistically significant changes in trimethoprim pharmacokinetic parameters in the presence of ganciclovir, with the exception of a 12.7% increase in Cmin. Ganciclovir was well tolerated when administered alone or in combination with trimethoprin. CONCLUSIONS: There was no clinically significant pharmacokinetic interaction between oral ganciclovir and trimethoprim when coadministered.

Administration, Oral↗
PubMed1999

Understanding Down's syndrome: a review.

Each year, one child in every 800 births in the U.S. is born with Down's syndrome. It is the most prevalent chromosomal abnormality found in humans. Of the approximately four million births in the U.S. per year, 5,000 newborns with Down's syndrome can be expected. All health care providers should understand the unique features of this condition. Likewise, dental hygienists should be cognizant of its specific oral manifestations to provide optimum oral care for these clients.

Dental Care for Persons with Disabilities↗
PubMed1999

Sexual risk behaviors of Gay, Lesbian, and bisexual youths in New York City: prevalence and correlates.

The lifetime and recent sexual risk behaviors of 156 Gay, Lesbian, and bisexual youths, recruited from Gay-focused organizations in New York City, were examined. The data indicated seven reasons why the youths are at risk for HIV and other STDs: They initiated sex during early adolescence; their first sexual partners were older than they were; HIV barrier methods (e.g., condoms) were initiated subsequent to sexual debut; many lifetime sexual partners and encounters were reported; some youths exchanged sex for goods; many youths reported having had at least one partner at risk for HIV; and the youths engaged in unprotected sexual behaviors during the past 3 months. Significant gender differences emerged (e.g., the male youths reported more lifetime same-sex partners than the female youths; the female youths reported more lifetime other-sex partners than the male youths). Recent sexual risk behaviors (i.e., numbers of same-sex partners, encounters, and unprotected sex during the past 3 months) were related significantly to the youths' average degree of emotional involvement in or average duration of intimate relationships.

Adolescent↗
PubMed1999

The stenosis ratio: a new tool for the diagnosis of degenerative spinal stenosis.

CLINICAL RELEVANCE: Low back pain from lumbar spinal stenosis is a significant source of morbidity, especially among the elderly population. Accurate diagnosis is imperative for effective treatment to be initiated. This paper presents a quantitative method for the evaluation of spinal stenosis that, when used in conjunction with CT and MRI, may greatly aid the clinician in the diagnosis of this debilitating condition. OBJECTIVE: Precise clinical tools for the diagnosis of spinal stenosis are severely lacking. Low back pain and dysfunction derived from lumbar spinal stenosis is a significant source of morbidity, especially among the elderly. Despite its importance, there has been little progress made towards establishing valid, quantitative criteria for the diagnosis of spinal stenosis. We present a new quantitative tool for the diagnosis of lumbar stenosis, the Stenosis Ratio (SR). METHODS: CT scans and MRI scans of 43 patients presenting with clinico-radiographic evidence of lumbar stenosis were used. The patient group consisted of 13 males and 30 females between the ages 49 and 82 with average age of 67. CT and MRI/scans of 43 patients were digitized and computer analyzed. Measurements of SR, defined as the ratio of the cross-sectional dural area of the motion segment to that of the stable segment, were established for L3-L4, L4-L5 and L5-S1 stenotic levels and compared to SR values for a non-stenotic (internal control) level, L2-L3. RESULTS: The L4-L5 level had the lowest SR value of 0.71, followed by 0.74 at L3-L4, and 0.87 at L5-S1. Ninety-five percent confidence intervals of (0.66, 0.81), (0.62, 0.81), and (0.73, 1.00) were found for SR values at levels L3-L4, L4-L5 and L5-S1 respectively. The SR at L2-L3 had a mean value of 1.37 with a 95% confidence interval of (0.970, 1.78). At all levels, SRs were significantly lower for the spinal stenotic L3-S1 levels than for the L2-L3 control as confirmed by a student's t-test (p < 0.05). CONCLUSION: In a select population of patients with spinal stenosis confirmed by neuroradiological assessment, values of SRs were consistently and significantly lower than controls. We believe that measurements of SRs may provide reproducible quantitative measures for the diagnosis of spinal stenosis. SR values below the 95% confidence limit may be indicative of lumbar stenosis. Through the use of ratios, inherent differences in patient size are controlled for, thus allowing comparison of values between patients and treatment groups and effective clinical diagnosis of spinal stenosis.

Adult↗