Biomedical subjects
Publications and source records attributed to J R Johnson.
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A new Intervertebral Motion Device (IMD) was developed in this study. Depending on its configuration, the IMD was used to measure motion in the sagittal, frontal, and transverse planes. Calibration results showed that the root-mean-square (RMS) error of the IMD was 0.092 mm in axial translation, 0.065 mm in shear translation, and 0.091 in rotation. Using the IMD, nine intact human lumbosacral spine specimens (L3-S1) were tested under a simulated physiological load on an MTS (Model 858 Bionix, MTS System Corporation Minneapolis, MN). The ranges of motion (ROMs) of intact and instrumented specimens were measured in terms of angular motion (main motion) and coupled translation in the sagittal plane, and angular motion in the transverse plane. The results demonstrated that simulated fusion with CS instrumentation at the level of L4-L5 significantly decreased the ROMs of L4-L5 for all main and coupled motions (P < 0.03). The application of CD rods had less influence on the angular ROM in L/R axial rotation compared to the angular ROMs in Flex/Ext and L/R lateral bending.
Antimicrobial prophylaxis against gram-positive bacteremia (GPB) following BMT may prevent infections but promote antimicrobial resistance. In a sequential cohort study involving 289 consecutive BMT recipients we compared three protocols for prevention of GPB (vancomycin prophylaxis, penicillin/cefazolin prophylaxis, and no specific GPB prophylaxis) with respect to incidence of GPB, mortality, and vancomycin use. GPB was associated with increased mortality (27% vs 15%; P = 0.02), but contributed to only five of 52 deaths in the study population, and only one of 15 subjects with viridans streptococcal bacteremia developed fatal septic shock. Vancomycin prophylaxis reduced the incidence of GPB (11%) compared to penicillin/cefazolin (27%) or no prophylaxis (40%) (all P < 0.03), but did not significantly reduce mortality. The incidence of fungemia, gram-negative bacteremia, and infection-associated mortality was unaffected by GPB prophylaxis. Vancomycin use was substantially greater in the vancomycin prophylaxis group. We conclude that in comparison with vancomycin prophylaxis, BMT support regimens that do not include vancomycin prophylaxis allow reduced overall vancomycin use without an apparent increase in early post-BMT mortality, despite the greater associated frequency of GPB.
The distribution of the three alleles of the P adhesin gene papG (classes I-III) was assessed among 74 Escherichia coli urine isolates from women with first-episode or recurrent cystitis, and papG genotype was compared with clinical origin, O serogroup, agglutination of Gal(alpha1-4)Gal-coated latex beads and human or sheep erythrocytes, and hemolysin production. The class-III-only papG genotype (27% of strains) predominated over the I + III (3%) and II-only (7%) genotypes, irrespective of clinical category. In contrast to the class II papG allele, the class III allele was significantly concentrated in serogroups O6 and O18. Agglutination phenotypes corresponded significantly but incompletely with papG genotype, whereas hemolysin production and papG positivity were tightly correlated. These findings suggest that in acute cystitis in adult women, the class III papG allele predominates, confers distinctive agglutination phenotypes, and is restricted to specific E. coli lineages.
The three alleles of papG, the Gal(alpha1-4)Gal-specific adhesin gene of Escherichia coli P fimbriae, were detected in 101 (54%) of 187 E. coli bacteremia isolates from Boston, Long Beach, California, and Nairobi, Kenya, by a polymerase chain reaction-based assay, and their distribution was compared with clonal structure and other bacterial and host characteristics. Allele II predominated overall (57% of papG+ strains, vs. 32% for III and 2% for I). Allele distribution differed significantly between centers. Alleles segregated according to enzyme electrophoretic lineage and O serogroup in patterns suggesting both vertical and horizontal transmission and emergence within E. coli in the temporal sequence II-->III-->I. Strains containing allele III preferentially agglutinated sheep erythrocytes, whereas strains containing allele II preferentially agglutinated human erythrocytes. Allele III was associated with hly, sfa, multiple copies of the pap operon, and cluster III of the phylogenetic tree. These findings indicate that among bacteremia isolates of E. coli, the three papG alleles exhibit distinctive associations with evolutionary lineages, hemagglutination phenotypes, and non-pap virulence properties.
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The prevalence of colonization with uropathogenic Escherichia coli and their reservoirs and routes of acquisition are incompletely defined. To help clarify these issues, polymerase chain reaction (PCR)-based strain typing assays were used to evaluate the fecal and vaginal E. coli flora of 11 volunteers. PCR detected the virulence genes papG, aer, and cnf significantly more frequently in mixed intestinal samples than in the corresponding predominant strains, evidence that traditional methods are suboptimal for detecting colonization with uropathogens. For strain typing, repetitive-element PCR was as discriminating as pulsed-field gel electrophoresis and O:H serotyping but more convenient. Molecular epidemiologic analysis of subjects' E. coli suggested emergence of occult uropathogenic strains from within the host's own intestinal flora, strain sharing between household members, and de novo acquisition of (unshared) uropathogenic strains. These methods should facilitate the studies needed to clarify the relative contributions of these three pathways to the pathogenesis of urinary tract infection.
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Data regarding the hemagglutination (HA) patterns of the three variants (classes I, II, and III) of the Escherichia coli adhesin PapG are conflicting. These HA patterns usually have been assessed for each papG allele separately with recombinant strains in slide HA assays. We rigorously evaluated an alternative microtiter tray HA assay and then used it to assess the HA of four erythrocyte types (human A1P1 and OP1, rabbit, and sheep erythrocytes) by multiple wild-type E. coli strains representing the four naturally occurring combinations of the papG alleles, i.e., class I plus III, class III only, class II plus III, and class II only. The microtiter tray HA assay displayed significantly better reproducibility of intraobserver (83%) and interobserver (86%) results than did slide HA assays (39 and 73%, respectively). Novel findings from the study of 32 wild-type P-fimbriated strains included reproducible determinations of phenotypic diversity among different papG categories, among strains within each papG category, and from day to day for individual strains. There was also substantial overlap of phenotypes between papG categories I plus III and III only and between II plus III and II only. A class III papG recombinant strain's HA pattern differed significantly from that of the wild-type class III strains. These data demonstrate that HA phenotypes of wild-type P-fimbriated E. coli strains can be reproducibly assessed by a microtiter HA assay and that they correspond broadly to papG genotype but in a more complex and varied fashion than previously recognized.
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Alleles I, II, and III of the P adhesin gene papG were sought by PCR among 75 Escherichia coli blood isolates from adults with urosepsis, and the papG genotype was compared with associated bacterial characteristics and host compromise status. Allele II predominated over allele III in the total population (71% of the strains versus 7% for allele III; P < 0.01). Allele I was not encountered. In comparison with allele II, allele III was significantly associated with the presence of hly and the absence of iuc (which encode hemolysin and aerobactin biosynthesis), nonagglutination of digalactoside-coated beads, absence of aerobactin production, membership in serogroups O6 and O18, and host compromise, particularly cancer and upper urinary tract abnormalities.
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This study examined preoperative SF-36 (Medical Outcomes Study Short Form 36-item questionnaire) data in patients who required a subsequent surgical procedure following lumbar spine fusion to identify potential predictors of this adverse surgical outcome. Of the 235 patients treated by lumbar fusion, 27 patients required an additional procedure. Analysis of preoperative SF-36 responses revealed higher scores in social function (P=.013), and pain (P=.021) for the 208 patients who underwent only the initial fusion versus the 27 patients requiring a subsequent intervention. This study suggests that components of the SF-36 carry prognostic value for lumbar spinal surgery.
This study determined the biomechanical differences between anterior and posterior lumbar interbody fusion (ALIF and PLIF). Ten cadaveric spines were tested. Five specimens had ALIF and five had PLIF at L4-L5. Stabilization was performed with pedicle screws and rods (Cotrel-Dubboset, Sofamor-Danek, Memphis, TN, U.S.A.). Angular motion was measured in flexion, extension, bending, and torsion on the intact, instrumented, and "fused" specimens. Instrumentation alone caused a significant decrease in segmental motion in all loading modes (p < 0.01). After the simulated fusion procedures, all specimens were most stable in flexion, and significantly less stable in extension (p = 0.04). Comparing directly, ALIF was significant more stable in left torsion (p = 0.03) with trends in left bending (p = 0.08) and right torsion (p = 0.07). Thus, from a purely biomechanical perspective, ALIF appears to be slightly superior to PLIF.
This study prospectively measured patient-reported quality-of-life outcome in patients undergoing fusion for recurrent symptoms after prior discectomy. Analysis of SF-36 data revealed statistically significant improvement in physical function, social function, and bodily pain 1 year postoperatively. Analysis of variance revealed significant interactions based on worker's compensation, litigation status, educational level, and age. The results support the conclusion that the SF-36 is a useful and applicable tool for measuring patient perception and quality-of-life parameters after spinal surgery. SF-36 outcomes demonstrated a reasonable level of success for lumbar fusion in revision spine surgery, with the most significant improvements noted in the categories of pain, physical function, and social function.
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Images of the martian surface returned by the Imager for Mars Pathfinder (IMP) show a complex surface of ridges and troughs covered by rocks that have been transported and modified by fluvial, aeolian, and impact processes. Analysis of the spectral signatures in the scene (at 440- to 1000-nanometer wavelength) reveal three types of rock and four classes of soil. Upward-looking IMP images of the predawn sky show thin, bluish clouds that probably represent water ice forming on local atmospheric haze (opacity approximately 0.5). Haze particles are about 1 micrometer in radius and the water vapor column abundance is about 10 precipitable micrometers.