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Biomedical subjects

J Marshall

Publications and source records attributed to J Marshall.

At least 721 records · Page 40Linked to original sources
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Surgical treatment of low backache and sciatica.

A comparison between 86 patients with low back pain who underwent surgery and 32 who did not showed that laminectomy is an effective treatment for many patients in whom conservative treatment has failed. Surgery should be undertaken sooner rather than later (preferably within a year), both because a good outcome is less likely with longer duration of symptoms and because long periods of disability and time off work can in this way be avoided.

Adult↗
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Continuous curvilinear capsulorhexis and intraocular lens biocompatibility.

PURPOSE: To study the influence of continuous curvilinear capsulorhexis (CCC) on poly(methyl methacrylate) (PMMA) intraocular lens (IOL) biocompatibility. METHODS: Biocompatibility was assessed by measuring the postoperative blood-aqueous barrier breakdown and the cellular reaction at the anterior capsule-IOL interface. In a prospective study, 30 consecutive eyes, normal except for having extracapsular cataract extraction (ECCE) with CCC by a single surgeon, has laser flare and cell measurements and specular microscopy of the anterior IOL surface at 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS: In addition to the foreign-body reaction previously described in eyes that had other capsulotomy types, the eyes in this study also had a lens epithelial cell (LEC) reaction. The severity of the foreign-body reaction and postoperative aqueous flare and cells was significantly less in eyes with an intact CCC than in those with rim tears in the capsulorhexis and in those having an ECCE with a linear or can-opener capsulotomy, as previously reported. CONCLUSIONS: Continuous curvilinear capsulorhexis improves the biocompatibility of PMMA IOLs to a degree that could be of clinical benefit. In eyes with CCC, most cells seen on the anterior IOL surface were LECs.

Biocompatible Materials↗
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Visual function: how spiders find the right rock to crawl under.

Animals that go on hunting expeditions face the problem of finding the way home at the end of the day. A group of hunting spiders has now been added to the list of animals that use the celestial pattern of polarized light as a compass to navigate with, and explains an old conundrum of spider eye anatomy.

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Drinking water, fluid intake, and bladder cancer in western New York.

Fluid intake and consumption of specific beverages were investigated in a study of 351 white male cases for whom transitional cell carcinoma of the bladder had been confirmed histologically during the time period from 1979 to 1985. A total of 855 white male controls was selected from Erie, Niagara, and Monroe counties of western New York state. Total fluid consumption was composed of alcoholic beverages, bottled beverages, soda, milk, coffee, tea, all juices, and glasses of tap water. Tap water included coffee, tea, juices, and glasses of water taken directly from the tap. Total fluid consumption was found to be a strong risk factor for bladder cancer when a number of potential confounding risk factors were controlled for. Risks were higher among those who were less than 65 y of age (odds ratio [OR] = 6.3, 95% C.I. = 2.8-14.0). The OR was 3.4 (95% C.I. = 1.8-6.2) for the highest quartile of fluid consumption among those 65 y of age and older. The tap water component was associated with increased risk in both age categories, and there was a clear dose-response relationship. Risks associated with tap water consumption were higher among those who never smoked cigarettes. Both biological and nonbiological explanations for these results are evaluated. The findings suggest implications for public health, but the limitations of the present investigation preclude definitive conclusions and stress the urgency for replication.

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Enhancing communication in jargon aphasia: a small group study of writing therapy.

People with jargon aphasia have severely disordered and incomprehensible speech that may be resistant to therapeutic intervention. In this study, we treated written output and examined whether it assisted communication for these clients. In stage one of the study, anagram sorting, delayed copying and lexical decision tasks were used to investigate the residual knowledge of written words in a group of ten people with jargon aphasia. Evidence of the presence of orthographic knowledge was taken as an indication that writing might be a useful focus for therapy. This hypothesis was explored in stage two with six clients. A personally useful vocabulary was selected for each, and copying, word completion and written picture-naming tasks were used in therapy to improve written production of these words. The clients made progress in written naming. However, they showed little change on a 'message' assessment that tested their ability to use the written words to convey messages. Stage three targeted communicative writing. Here, three of the clients received 'message therapy', which encouraged them to relate treated words to functional messages and to communicate them to a partner. The clients improved on the message assessment and observation of their communication and reports from relatives suggested that they made functional use of writing in a range of communication settings.

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Written communication in undifferentiated jargon aphasia: a therapy study.

A subject, R.M.M., with a 2-year history of jargon aphasia is described. At the beginning of this study she had minimal meaningful spoken output and showed little awareness of her speech despite having relatively well-preserved auditory comprehension. Her spoken output had proved resistant to earlier periods of therapy. In contrast, R.M.M.'s written output showed some ability to access orthographic information and monitoring of this modality was shown by an acute awareness of her errors. A 3-stage therapy programme is described. This was designed to improve R.M.M.'s writing of single words and to encourage use of writing as an alternative means of communication. The initial stage of therapy aimed to increase R.M.M.'s access to written word forms by use of picture stimuli. She showed significant improvement in writing treated items in response to pictures both immediately after therapy and at re-assessment 6 weeks later. Despite the acquisition of these skills, R.M.M. failed to use them in communicative contexts. A second stage of therapy replicated the results of the first and sought to facilitate R.M.M.'s functional use of her written vocabulary by asking her to write words to spoken questions. She again showed improved written naming of the treated items and could now produce written names appropriately in a questionnaire-type assessment. Generalization of this ability extended to items that had not been trained in this way. Functional use of writing in everyday communication remained absent, however. The final stage of therapy made explicit the potential links between items which R.M.M. could now write and functional messages which they might convey. She again showed significant changes in the acquisition of new vocabulary and, encouragingly, progress was also seen in her use of the strategy in functional communication. R.M.M.'s speech is almost entirely incomprehensible. It has remained unchanged for 2 years and has not responded to therapy. Relatively well-preserved auditory comprehension and good monitoring of written output allowed therapy to effectively target a small written vocabulary. Despite significant progress in the acquisition of new items, transfer of this skill to functional communication was initially absent. Further therapy which specifically targeted the impairment causing this failure was needed before functional use was seen. The potential for treating written output in cases of jargon aphasia which have been resistant to therapy for spoken language is discussed.

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Drawing together: evaluation of a therapy programme for severe aphasia.

This paper reports a therapy study that aims to promote communicative drawing in a group of seven people with severe and long-standing aphasia. Therapy was conducted on individual and group bases over 12 weeks and entailed a range of techniques which are described in some detail. Treatment was evaluated using a novel generative drawing assessment in which subjects were required to draw absent items in response to photographic and conversational cues. Pre- and post-therapy assessments of untreated skills, such as comprehension, naming and gesture, were also conducted. The results indicated that, as a group, the subjects' drawing improved. Unchanged performance on the other assessments indicated that the gains were specific to the content of therapy and could not be attributed to spontaneous recovery. Pre- and post-therapy interviews with carers (i.e. relatives and close friends of the individuals) suggested that the effects of therapy were also being felt in the home. These results have important implications for therapy with people with severe aphasia.

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A multicentre, randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of alcohol dependence or abuse.

The opioid antagonist, naltrexone, is reported, in single centre studies, to improve the clinical outcome of individuals with alcohol dependence participating in outpatient psychosocial programmes. This is the first multicentre controlled study to evaluate the efficacy and safety of naltrexone as adjunctive treatment for alcohol dependence or abuse. Patients who met criteria for alcohol dependence (n = 169) or alcohol abuse (n = 6) were randomly assigned to receive double-blind oral naltrexone 50 mg daily (n = 90) or placebo (n = 85) for 12 weeks as an adjunct to psychosocial treatment. The primary efficacy variable was time to first episode of heavy drinking; secondary efficacy assessments included time to first drink, alcohol consumption, craving, and changes in the serum biological markers gamma-glutamyl transferase (GGT), and aspartate and alanine aminotransferases. Compliance was assessed by tablet counts and, in the naltrexone-treated group, by measurement of urinary concentrations of 6-ss-naltrexol. Forty-nine (58%) patients randomized to placebo and 53 (59%) randomized to naltrexone did not complete the study. In intention-to-treat analyses, there was no difference between groups on measures of drinking. The median reduction from baseline of serum GGT (P: < 0.05) and the reductions in alcohol craving (Obsessive and Compulsive Drinking Scale: OCDS) were greater in the naltrexone group (P: < 0.05), from approximately half-way through the study. Of 70 patients (35 placebo; 35 naltrexone) who met an a priori definition of compliance (80% tablet consumption, attendance at all follow-up appointments), those allocated to naltrexone reported consuming half the amount of alcohol (P: < 0.05), had greater median reduction in serum GGT activity (P: < 0.05), and greater reduction in alcohol craving (OCDS total score: P: < 0.05; Obsessive subscale score: P: < 0.05), compared to patients in the placebo group. Use of naltrexone raised no safety concerns. Naltrexone is effective in treating alcohol dependence/abuse in conjunction with psychosocial therapy, in patients who comply with treatment.

Adult↗
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Health care professionals referred for treatment of alcohol and drug problems.

This study reports on 62 health care professionals referred to a specialist drug and alcohol treatment service. Most patients used more than one type of substance. Health problems were common, but were seldom reasons for referral. Self-referral was infrequent. Referral was often subsequent to intoxication at work or persistent absenteeism. Just over half of admissions completed treatment. Multiple drug use was a poor prognostic indicator with fewer multiple drug users engaging with, or completing, treatment.

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Retarded fetal brain development resulting from severe dietary iodine deficiency in sheep.

Sheep have been used to study the effect of dietary iodine deficiency on the development of the fetal brain. Severe iodine deficiency caused reduction in fetal brain and body weights and in brain DNA and protein from 70 days gestation to parturition. The lowered brain weight and brain DNA at 70 days gestation indicates a reduced number of cells, probably due to slower neuroblast multiplication which normally occurs from 40-80 days in the sheep, and the reduction in DNA and protein after 80 days implies that the development of neuroglia could be slowed also in iodine deficiency. Morphological changes were observed in both the cerebral hemispheres and the cerebellum. In the cerebral hemispheres of the iodine-deficient fetuses an increased density of neurons was apparent histologically in the motor cortex and visual cortex and in the CA1 and CA4 areas of the hippocampus in comparison with controls. In the cerebellum there was delayed migration of cells from the external granular layer to the internal granular layer and increased density of Purkinje cells in the iodine-deficient fetal brains. In addition, the molecular area was increased and the medullary area reduced in comparison with controls. These change are indicative of delayed brain maturation. Evidence of fetal hypothyroidism was provided by low fetal thyroid iodine and plasma T4 values, thyroid hyperplasia from 70 days gestation, significant reduction in body weight at the same time as the brain retardation, and absence of wool growth and delayed skeletal maturation near parturition. It is apparent from the biochemical and histological changes observed during iodine deficiency that iodine is an essential element for normal fetal brain and physical development in the sheep.

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Developmental trends in voice onset time: some evidence for sex differences.

This study reports on an investigation into the voice onset time (VOT) patterns of the plosives /p b t d/ in a group of 30 children aged 7 (n = 10), 9 (n = 10) and 11 (n = 10) years. Equal numbers of girls and boys participated in the study. Each child named a series of letter objects to elicit /p b t d/ in a syllable onset position with a fixed vowel context. VOT data were examined for age, sex and plosive differences with the following hypotheses: Firstly, that there would be sex differences in the VOT patterns of preadolescent children. Secondly, that the sex differences in VOT patterns would be linked to age and development, and that these would eventually become marked by the age of 11 years, by which time adult-like VOT values should have been achieved. Finally, that the extent of sex and age differences would be dependent upon the plosive being investigated. Results indicated patterns of decrease with age in the VOT values of /p b/ for the boys, with some evidence of increases in the VOT values of /t/ for the girls. In addition, 'voiced' and 'voiceless' cognates showed a more marked bimodal distribution in the girls' VOT patterns. This bimodal distribution was investigated by examining the degree of difference between the VOT values of voiced and voiceless cognate pairs /p b/ and /t d/, and examining the effects of age, sex and cognate pair. These results indicated that more marked sex differences in the 'voiced'/'voiceless' contrast emerged between the data of the 9- and 11-year-olds, a pattern, which was more marked for the alveolar plosives. These preliminary results confirmed all three hypotheses. The findings are presented and discussed both within a developmental and sociophonetic framework.

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Effects of chemotherapy and tamoxifen on cervical and vaginal smears in bone marrow transplant recipients.

OBJECTIVE: To clarify the importance of squamous and glandular atypia in the genital tracts of women undergoing high-dose chemotherapy and receiving tamoxifen. STUDY DESIGN: The pathology records of 769 female bone marrow transplant recipients from a five-year period at Duke University Medical Center were reviewed. One hundred fifteen cervicovaginal smears from 78 patients were available for evaluation; of these, 85 smears from 61 patients were selected. Only cases from patients with a complete medical history, including menopausal status and therapeutic regimen, were included in this study. Forty-five cases were from patients treated with chemotherapy alone, and 40 were from patients treated with a combination of chemotherapy and tamoxifen. RESULTS: A normal cellular pattern was the most common finding. Reactive cellular changes associated with therapy effect were identified in 21% of cases. In patients treated with chemotherapy alone, an atrophic smear pattern in a premenopausal woman was identified in 27% of cases. Squamous epithelial cell abnormalities were identified in approximately the same proportion of patients whether they received chemotherapy alone or with tamoxifen. Glandular changes were uncommon. CONCLUSION: The most common finding was a normal smear pattern. An atrophic smear was more commonly found in patients treated with chemotherapy alone than in those treated with both chemotherapy and tamoxifen. Squamous epithelial cell abnormalities are most probably independent of treatment effect. Glandular changes were rare in patients treated with chemotherapy, alone or in combination with tamoxifen.

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