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Biomedical subjects

J M Fletcher

Publications and source records attributed to J M Fletcher.

At least 109 records · Page 6Linked to original sources
PubMed1994

Gunshot wounds to the brain in children and adolescents: age and neurobehavioral development.

Neurobehavioral outcome after craniocerebral gunshot wounds was evaluated in a prospective, 3-year, longitudinal follow-up of a consecutive case series of 13 children and adolescents. The younger group was composed of seven children, ages 1.5 to 4 years, and the older group contained six children, ages 5 to 14. Outcome measures included the Glasgow Outcome Scale and neuropsychological assessment of intelligence, language, motor, memory, attention, academic achievement, and adaptive behavior. Glasgow Outcome Scale scores at baseline indicated moderate and severe disabilities in 69 and 23%, respectively. At the 3-year follow-up, 85% had moderate disabilities but only 8% were severely disabled. Significant and persistent neurobehavioral deficits varied with developmental level at the time of cerebral insult. Intellectual functioning was clearly more impaired in children younger than 5 years of age at the time of injury than in older children. Cognitive and motor factors were most closely related to deficits in the younger group. Disability in older children and adolescents was associated with impaired attention, adaptive behavior, and behavioral disturbance. Disabilities appear to be at least as severe in our sample after cerebral gunshot wounds as in our studies of severe pediatric closed-head injury. At the time of follow-up, younger children sustaining gunshot wounds had slightly lower intelligence quotient scores and similar receptive language, expressive language, and gross motor scores compared with children with severe closed-head injury. The older gunshot wound patients were significantly more impaired than patients with severe closed-head injuries on measures of adaptive behavior and attention.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

The influence of maternal nutrition on muscle fiber number development in the porcine fetus and on subsequent postnatal growth.

In the pig, undernutrition in utero causes low birth weight, a decrease in muscle fiber number, and a reduction in postnatal growth rate. The effect on fiber number is mediated via a reduced secondary fiber population. Within a litter of pigs, lighter-weight pigs have probably suffered some deficit in muscle fiber number. In an attempt to improve the number of fibers in the lighter-weight pig fetuses, four maternal feeding regimens were used, one serving as the control. Maternal feed intake was doubled for one of three time periods during pregnancy: 1) d 25 to 50 (HE) immediately before fiber hyperplasia; 2) d 50 to 80 (HL) during fiber hyperplasia; or 3) d 25 to 80 (HT) covering both developmental events. Controls were fed at levels routinely used for pregnant sows on the farm. Sows farrowed normally and pig birth weights were recorded. Estimates were made of total myofiber number, total primary fiber number, and mean secondary:primary fiber number ratio (S:P) for the semitendinosus of each pig at 5 wk postnatal or 80 kg (HT and two control litters only). The progeny of all supplemented sows had a significantly greater mean S:P ratio (P < .05), and the HE pigs tended to have a greater number of muscle fibers than control pigs (403,840 +/- 8,197 vs 370,970 +/- 12,720). Postnatal growth rate to 80 kg was also investigated for the HT group of pigs.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1993

Cognition in relation to magnetic resonance imaging in head-injured children and adolescents.

To investigate the relationship between cognitive sequelae and magnetic resonance imaging (MRI) findings following closed head injury of varying severity in the pediatric age range, 76 head-injured children and adolescents were studied at least 3 months after trauma and compared with 57 normal controls. Problem solving, planning, verbal and design fluency, memory, and response modulation were assessed. Significant effects of injury were obtained on all of the cognitive measures. Cognitive impairment was more consistently present on the various outcome measures in children who were 6 to 10 years old at the time of the study than in the older children and adolescents. Magnetic resonance imaging disclosed areas of abnormal signal in the frontal lobes of 42 patients, whereas focal lesions restricted to the extrafrontal region were found in 15 children. Regression analyses disclosed that taking into account the size of frontal lobe lesion enhanced the relationship between cognitive performance and the severity of injury.

Adolescent↗
PubMed1993

Colocalization of the human CD59 gene to 11p13 with the MIC11 cell surface antigen.

The human CD59 gene encodes a cell surface antigen detected by MEM43 and other antibodies. It has homology to the mouse Ly-6 genes that map on mouse chromosome 15 and are involved in lymphocyte signal transduction. CD59 may play a role in protecting against complement-mediated lysis. The human CD59 gene had been previously localized to 11p13-p14. We expected, on the basis of synteny arguments, that CD59 would map in 11p14. However, we have precisely localized the human CD59 gene to band p13 of chromosome 11 by somatic cell genetics and by pulsed-field gel electrophoresis; indeed the gene is often deleted in WAGR individuals. This region of chromosome 11 is syntenic with mouse chromosome 2. This suggests that CD59 is not a homolog of the mouse Ly-6 genes on mouse chromosome 15, but rather is a related gene. The human CD59 gene is shown to map within 500 kb of another cell surface marker, MIC11, the gene for which has not been cloned. This localization and the results of immunoprecipitation experiments suggest that the CD59 gene could encode the MIC11 antigen; alternatively this region of 11p13 may contain a cluster of genes encoding cell surface molecules.

Animals↗
PubMed1993

Longitudinal outcome for low birth weight infants: effects of intraventricular hemorrhage and bronchopulmonary dysplasia.

This study addresses the mental and motor development of 78 low birth weight infants (LBW) classified into five groups according to early medical complications: (1) respiratory distress syndrome (RDS); (2) intraventricular hemorrhage (IVH Grades I-II); (3) IVH (Grade III); (4) IVH (Grade IV) with hydrocephalus; and (5) bronchopulmonary dysplasia (BPD) with or without IVH. Each child received an assessment of mental and motor development at 6, 12, 24 and 36 months of age. Results of mental scores revealed clear effects of group and age, but no interaction of group and age. The RDS and IVH (Grades I-III) groups generally had higher scores on indices of mental development than did IVH (Grade IV) and BPD infants with or without IVH. Although most groups had higher mental scores at the older ages, rates of growth were essentially parallel across the five groups. There was some support for differential rates of motor development, with the IVH (Grade IV) group showing acceleration between 24 and 36 months of age while the BPD group continued to show motor delay at 36 months. These results call into question the common practice of correcting psychology test scores of LBW infants for gestational age.

Bronchopulmonary Dysplasia↗
PubMed1993

Attentional disturbance after pediatric closed head injury.

The influence of severity of closed head injury and age on attentional functioning was prospectively investigated in 36 children (age range, 7 to 16 years) 6 months after injury. Children were placed into mild, moderate, and severe injury groups using established neurologic criteria. Each child received the Wechsler Intelligence Scale for Children-Revised Digit Span subtest and a continuous performance test. Children with severe closed head injury demonstrated significantly poorer continuous performance test scores than mildly or moderately injured children. Injury severity had no effect on Digit Span scores. Younger children exhibited more pronounced impairment on the continuous performance test relative to uninjured age peers. These results extend the persistence of attentional impairments beyond those of previous reports. Closed head injury is not associated with preferential sparing of sustained attention in younger children 6 months after injury. Brain injury earlier in life may result in delayed vulnerability of information processing skills.

Adolescent↗
PubMed1993

Muscle cellularity and postnatal growth in the pig.

Fast-growing strains of pigs and of other animals tend to have more muscle fibers than do slow-growing strains. The relationship between fiber number and growth rate was extended by examining pigs within the same strain. Seven litters of pigs (n = 66) were weighted at monthly intervals from birth to approximately 80 kg. The semitendinosus muscle was removed and an estimation of total fiber number, total primary fiber number, and mean secondary:primary fiber number (S:P) ratio was made for each animal. Pig growth was divided into three approximately linear phases: birth to 6 kg, 6 to 25 kg, and 25 kg to slaughter weight. Average daily gain in the first two phases was correlated with birth weight (r = .3614, P < .05 and r = .5873, P < .001, respectively) but was not correlated with total muscle fiber number. In the third growth phase ADG was correlated with muscle fiber number (r = .4149, P < .001) and was not correlated with birth weight. The gain:feed ratio was also calculated for each pig during the third growth phase and was found to be correlated with fiber number (r = .4191, P < .001). These results suggest that muscle fiber number is an important determinant of postnatal growth such that pig littermates with a high fiber number tend to grow faster and more efficiently than littermates with a lower fiber number.

Animals↗
PubMed1993

Schizophrenia-associated chromosome 11q21 translocation: identification of flanking markers and development of chromosome 11q fragment hybrids as cloning and mapping resources.

Genetic linkage, molecular analysis, and in situ hybridization have identified TYR and D11S388 as markers flanking the chromosome 11 breakpoint in a large pedigree where a balanced translocation, t(1;11)(q43;q21), segregates with schizophrenia and related affective disorders. Somatic cell hybrids, separating the two translocation chromosomes from each other and from the normal homologues, have been produced with the aid of immunomagnetic sorting for chromosome 1- and chromosome 11-encoded cell-surface antigens. The genes for two of these antigens map on either side of the 11q breakpoint. Immunomagnetic bead sorting was also used to isolate two stable X-irradiation hybrids for each cell-surface antigen. Each hybrid carries only chromosome 11 fragments. Translocation and X-irradiation hybrids were analyzed, mainly by PCR, for the presence of 19 chromosome 11 and 4 chromosome 1 markers. Ten newly designed primers are reported. The X-irradiation hybrids were also studied cytogenetically, for human DNA content, by in situ Cot1 DNA hybridization and by painting the Alu-PCR products from these four lines back onto normal human metaphases. The generation of the translocation hybrids and of the chromosome 11q fragment hybrids is a necessary preliminary to determining whether a schizophrenia-predisposition gene SCZD2 is encoded at this site.

Animals↗
PubMed1992

An in-practice training scheme for cardiopulmonary resuscitation (CPR).

Patient collapse is a problem requiring rapid and effective management. The Mersey Region strategy for preparing dentists and practice personnel to deal with this situation is to train them by means of practical teaching courses held in the dental surgery. The nature of this course is described.

Cardiopulmonary Resuscitation↗
PubMed1992

Evidence that dyslexia may represent the lower tail of a normal distribution of reading ability.

BACKGROUND: Dyslexia is now widely believed to be a biologically based disorder that is distinct from other, less specific reading problems. According to this view, reading ability is considered to follow a bimodal distribution, with dyslexia as the lower mode. We hypothesized that, instead, reading ability follows a normal distribution, with dyslexia at the lower end of the continuum. METHODS AND RESULTS: We used data from the Connecticut Longitudinal Study, a sample survey of 414 Connecticut children who entered kindergarten in 1983 and were followed as a longitudinal cohort. Dyslexia was defined in terms of a discrepancy score, which represents the difference between actual reading achievement and achievement predicted on the basis of measures of intelligence. Data were available from intelligence tests administered in grades 1, 3, and 5 and achievement tests administered yearly in grades 1 through 6. For each child there were 108 possible discrepancy scores ([3 x 3 years] x [2 x 6 years]) based on combinations of the ability scores (full-scale, verbal, and performance IQ) in each of three years and two achievement scores (reading and mathematics) in each of six years. We demonstrated that each of the discrepancy scores followed a univariate normal distribution and that the interrelation of two different discrepancy scores followed a bivariate normal distribution. At most, only 9 of 108 discrepancy scores (8.3 percent) and 171 of 3402 pairs of discrepancy scores (5.0 percent) were significantly different (at the 5 percent level) from the expected scores--well within the expected values for data with univariate and bivariate normal distributions, respectively. We also examined the stability of dyslexia over time. The normal-distribution model predicted (and the data indicated) that only 7 of the 25 children (28 percent) classified as having dyslexia in grade 1 would also be classified as having dyslexia in grade 3. CONCLUSIONS: Reading difficulties, including dyslexia, occur as part of a continuum that also includes normal reading ability. Dyslexia is not an all-or-none phenomenon, but like hypertension, occurs in degrees. The variability inherent in the diagnosis of dyslexia can be both quantified and predicted with use of the normal-distribution model.

Child↗
PubMed1992

Cerebral white matter and cognition in hydrocephalic children.

Although children with hydrocephalus frequently show poor development of nonverbal cognitive skills relative to verbal skills, little is known about the neuropathologic correlates of these discrepancies. In this study, cerebral white-matter structures and lateral ventricles were measured from the magnetic resonance images of age-matched children with meningomyelocele, meningocele, and aqueductal stenosis and normal subjects. The volume of each lateral ventricle and the cross-sectional area of the corpus callosum and internal capsules were correlated with concurrent measures of verbal and nonverbal cognitive skills. The corpus callosum in the meningomyelocele and aqueductal stenosis groups was smaller. The lateral ventricles were larger, and the internal capsules were smaller, in all patient groups than in normal subjects. There were no differences in the size of the centra semiovale. Although verbal and nonverbal measures correlated positively with the size of the corpus callosum, the correlation was higher for nonverbal measures. Nonverbal measures correlated with the right, but not the left, lateral ventricle and with the area of the right and left internal capsules. Verbal measures correlated with the left, but not right, lateral ventricle and with the left, but not right, internal capsule. These results show a relationship between the corpus callosum and cognitive skills that is also influenced by hydrocephalus-related changes in the lateral ventricles and other cerebral white-matter tracts.

Adolescent↗
PubMed1992

Narrative discourse after closed head injury in children and adolescents.

This study examined narrative discourse in 20 children and adolescents at least 1 year after sustaining a head injury. Narratives were analyzed along the dimensions of language structure, information structure, and flow of information. Severity of impaired consciousness was associated with a significant reduction in the amount of language and information. The most important finding which emerged was the disruption in information structure. This pattern confirms the impression of disorganized discourse in severely injured children. Explanations for the disruption in information structure are explored in terms of the role of vocabulary, memory, and localization of lesion according to magnetic resonance imaging. In view of recent evidence that frontal lobe damage is associated with discourse formulation deficits in adults and is the most common site of focal lesion in closed head injury, we examined discourse patterns in individual patients with frontal lobe lesions. Preliminary data from our single-case studies suggest discourse patterns similar to those reported for adults with frontal lobe injuries.

Adolescent↗
PubMed1992

Verbal and nonverbal skill discrepancies in hydrocephalic children.

This study evaluated a large sample (N = 90) of 5- to 7-year-old children with hydrocephalus caused by aqueductal stenosis or prematurity-intraventricular hemorrhage or associated with spina bifida. Comparison groups of normal controls, children with spina bifida and no shunt, and premature children with no hydrocephalus were also evaluated. Comparison of skill discrepancies at two occasions separated by 1 year revealed that hydrocephalic children, as a group, showed poorer nonverbal than verbal skills on measures from the McCarthy Scales of Children's Abilities, the WISC-R, and composites of neuropsychological skills. No discrepancies in verbal-nonverbal memory were found nor were any discrepancies attributable to etiology or motor demands of the tasks. Consistent with current hypotheses concerning the role of the cerebral white matter in cognitive development, these results show that hydrocephalic children in this age range generally have poorer development of nonverbal cognitive skills relative to their language development.

Child↗
PubMed1992

A five-factor model for motor, psychomotor, and visual-spatial tests used in the neuropsychological assessment of children.

Previous confirmatory factor analysis has supported a distinction between simple and complex motor skill tests in a modified and expanded Halstead Reitan test battery (HRB). The present study used a sample of 722 right-handed boys and girls, aged 9 through 12, and expanded the sample of motor, psychomotor, and visual-spatial tests to further clarify this distinction. Restricted maximum-likelihood factor analysis resulted in correlated factors of Simple Motor Skill, Complex Visual-Spatial Relations, Simple Spatial Motor Operations, Motor Steadiness, and Speeded Motor Sequencing. These results provide additional evidence for the discriminant validity of this particular battery of tests, and explicate further the skills and abilities measured in neuropsychological assessments of children referred for evaluation.

Adolescent↗
PubMed1992

Electrophysiological evidence of lateralized disturbances in children with learning disabilities.

This study used an electrophysiological measurement operation to investigate lateralized processing deficits associated with academic learning-disability subtypes. Fast frequency EEG activity in the 36-44 hertz (Hz) band was recorded from reading-disabled (RLD), arithmetic-disabled (ALD), and nondisabled control children engaged in verbal and nonverbal cognitive tasks. The control group, but neither LD group, exhibited a task-dependent shift in lateralization of 40 Hz EEG; the RLD subjects generated proportionately less left-hemisphere 40 Hz activity than control or ALD subjects during the verbal task; and the ALD subjects generated proportionately less right-hemisphere activity than control or RLD subjects during the nonverbal task. These results indicate that lateralized processing deficits are associated with different types of disabilities, and provide external validation of learning-disability classifications based on academic performance patterns.

Adolescent↗