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Biomedical subjects

M James

Publications and source records attributed to M James.

At least 109 records · Page 6Linked to original sources
PubMed1995

What method should be used to define 'night' when assessing diurnal systolic blood pressure variation in the elderly?

Diurnal blood pressure (BP) variation can be assessed by cusums-derived measures and by the day-night BP difference from time-, activity- and diary-defined 'night' periods. Reproducibility of diurnal systolic BP (SBP) variation by these different methods was studied in 19 active elderly normotensives, mean age 68.5 years. Subjects underwent simultaneous 24 h BP (Spacelabs 90207) and activity (Gaehwiler wrist actigraph) monitoring on two occasions (median interval 70 days). On the first occasion, mean diurnal SBP variation was 15.1 +/- 8.1 mm Hg by fixed-time definition of 'night' (22.07). When compared with 22-07 defined 'night' period, actigraph- and diary-defined 'night-time' was significantly reduced (-60 +/- 49, and -48 +/- 51 min, respectively) and consequently diurnal SBP variation was significantly greater at 18.2 +/- 8.1 mm Hg and 17.6 +/- 8.4 mm Hg, respectively. Actigraph recordings were also used to exclude 'night' BP readings associated with activity, but this did not significantly alter the diurnal SBP variation. Cusums-derived circadian alteration magnitude resulted in the greatest value for SBP variation (23.4 +/- 6.7 mm Hg). However, reproducibility of diurnal SBP variation was poor by fixed-time method with a coefficient of variation (CV) of > 50%, and only improved to 40% with diary use. Actigraph measurements, even if used to exclude BP values associated with disturbed sleep, did not improve this further. Cusums-derived measures of diurnal variation slightly improved reproducibility with a CV of 34.6% and may be a better method in the assessment of diurnal BP variation in the elderly.

Aged↗
PubMed1994

Farm health and safety in rural New South Wales. Insights through qualitative research.

OBJECTIVES: To determine the appropriate content and format of a farm health and safety training program for rural health professionals, and to explore issues in rural health care relevant to the health and safety education of the farming community. DESIGN: Qualitative research by focus group and individual interviews with health care professionals and members of the farming community. SETTING: Four rural New South Wales towns, with a range of agricultural activities. PARTICIPANTS: One hundred and sixteen health care professionals and 58 people who lived or worked on farms were interviewed. RESULTS: Suggestions were made for field days and seminars to provide information on agricultural hazards. Doctors were the most common first contact for health care but were rarely involved in preventive health care. Members of the farming community largely believed that they got the health care that they requested from their doctors. Community health teams provided preventive health care but rarely received referrals from doctors. Doctors often saw the farming community according to a stereotype of "the man on the land" that discouraged preventive health care interventions. CONCLUSION: Current patterns of health care service in rural communities inhibit the opportunities for effective farm health and safety education. A training program in farm health and safety could meet the needs of rural health professionals and the community if it encouraged greater use of a wider range of health care professionals as providers of preventive health care.

Adult↗
PubMed1994

Hormonal carcinogenesis in breast cancer: cellular and molecular studies of malignant progression.

We have established and characterized a series of variant cell lines in which to identify the critical factors associated with E2-induced malignant progression, and the acquisition to tamoxifen resistance in human breast cancer. Sublines of the hormone-dependent MCF-7 cell line (MCF7/MIII and MCF7/LCC1) form stable, invasive, estrogen independent tumors in the mammary fat pads of ovariectomized athymic nude mice. These cells retain expression of both estrogen (ER) and progesterone receptors (PGR), but retain sensitivity to each of the major structural classes of antiestrogens. The tamoxifen-resistant MCF7/LCC2 cells retain sensitivity to the inhibitory effects of the steroidal antiestrogen ICI 182780. By comparing the parental hormone-dependent and variant hormone-independent cells, we have demonstrated an altered expression of some estrogen regulated genes (PGR, pS2, cathepsin D) in the hormone-independent variants. Other genes remain normally estrogen regulated (ER, laminin receptor, EGF-receptor). These data strongly implicate the altered regulation of a specific subset or network of estrogen regulated genes in the malignant progression of human breast cancer. Some of the primary response genes in this network may exhibit dose-response and induction kinetics similar to pS2, which is constitutively upregulated in the MCF7/MIII, MCF7/LCC1 and MCF7/LCC2 cells.

Adenocarcinoma↗
PubMed1994

Cognitive deficits in progressive supranuclear palsy, Parkinson's disease, and multiple system atrophy in tests sensitive to frontal lobe dysfunction.

Groups of patients with idiopathic Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy or Steele-Richardson-Olszewski syndrome, matched for overall clinical disability, were compared using three computerised cognitive tests previously shown to be sensitive to frontal lobe dysfunction. On a test of planning based on the Tower of London task, all three groups were impaired, but in different ways. The groups with palsy and Parkinson's disease were slower in the measure of initial thinking time, whereas the group with multiple system atrophy was only slower in a measure of thinking time subsequent to the first move, resembling patients with frontal lobe damage. On a test of spatial working memory, each group showed deficits relative to their matched control groups, but the three groups differed in their strategy for dealing with this task. On a test of attentional set shifting, each group was again impaired, mainly at the extradimensional shifting stage, but the group with Steele-Richardson-Olszewski syndrome exhibited the greatest deficit. The results are compared with previous findings in patients with Alzheimer's disease or frontal lobe damage. It is concluded that these basal ganglia disorders share a distinctive pattern of cognitive deficits on tests of frontal lobe dysfunction, but there are differences in the exact nature of the impairments, in comparison not only with frontal lobe damage but also with one another.

Aged↗
PubMed1993

Effect of seeding time and density on endothelial cell attachment to damaged vascular surfaces.

An in vitro model to facilitate the study of endothelial cell seeding of damaged vascular surfaces has been developed. This may have applications in the study of endothelial seeding of angioplasty and endarterectomy sites. Using this model, the optimum endothelial seeding time for attachment to damaged vascular surfaces should not exceed 30 min and, to achieve confluent cell attachment, a seeding density > 5 x 10(5) cells/cm2 should be used.

Angioplasty, Balloon↗
PubMed1993

Visuospatial memory deficits at different stages of Parkinson's disease.

Groups of patients with idiopathic Parkinson's disease (PD), either medicated or unmedicated, were compared with matched groups of normal controls on a computerised battery of tests designed to investigate spatial working memory, visuospatial recognition memory and learning. The medicated PD patients were subdivided into those with mild and severe clinical disability on the basis of Hoehn and Yahr ratings, thus making three groups of PD patients in all. In a test of spatial recognition memory, a significant impairment was only evident in those PD patients who were medicated and had severe clinical symptoms (Hoehn and Yahr stage III-IV). In contrast, none of the three patient groups were impaired in a complementary test of visual pattern recognition memory. Whilst all three patient groups performed well in a test of simultaneous visual matching to sample, medicated patients (MED PD) with severe clinical symptoms were significantly impaired when a short (0-12 sec) delay was introduced. In a test of paired associates learning requiring both visual pattern and visuospatial memory, deficits in learning and memory were only evident in the severely impaired MED PD group. In contrast, in a test of spatial working memory known to be sensitive to frontal lobe damage, significant impairments were found in both groups of medicated PD patients and particularly in those patients with more severe clinical symptoms. Taken together, the results suggest that there are multiple memory impairments in PD which may differentially depend on the clinical severity of the disease.

Aged↗
PubMed1993

The Teller acuity card procedure. Three testers in a clinical setting.

PURPOSE: The Teller acuity card procedure provides a quantitative measure of grating acuity in infants and young children and has been used in clinical and laboratory settings. The purpose of this study is to address the influence of the individual testers in a clinical setting. The authors report a comparison of acuity results obtained by three well-trained, experienced testers in a busy hospital-based clinical practice. METHODS: Three different testers (A, B, C) performed 971 consecutive acuity assessments using the Teller acuity card procedure on 570 patients. The testers used similar techniques and adaptations, depending on clinical need. Diagnostic categories include nystagmus, aphakia, strabismus, glaucoma, retinopathy of prematurity (ROP), ptosis, optic nerve abnormalities, etc. Patients ranged in age from 2 weeks to 17 years (mean +/- standard deviation, 23 +/- 20 months). RESULTS: When each patient was represented only once, A tested 144 patients; B, 251; and C, 175. The geometric mean right eye acuity scores of A were 3.00 cycles/degree (cy/deg) (0.34 octaves, standard error [SE]; n = 134); B, 4.05 cy/deg (0.20 octave, SE; n = 225); and C, 3.71 cy/deg (0.30 octave, SE; n = 163). An analysis of covariance showed a significant difference in the mean log scores across testers (P = 0.02 adjusted for both age and diagnosis). Age was a strong predictor of acuity (P = 0.0001), and the interactions between tester and age and tester and diagnosis were not significant. The geometric mean left eye acuity scores for A were 2.86 cy/deg (0.33 octave, SE; n = 132); B, 3.46 cy/deg (0.23 octave, SE; n = 218); and C, 3.32 cy/deg (0.30 octave, SE; n = 160). The differences for left eyes among testers were not significant (P = 0.37 adjusted for age and diagnosis). CONCLUSIONS: These results suggest that the tester may influence the acuity results measured by the Teller acuity card procedure in a clinical setting. Evaluation of interobserver reliability in clinical subjects should be a high priority of further work using the Teller acuity card procedure.

Adolescent↗
PubMed1993

A cosmid contig and high resolution restriction map of the 2 megabase region containing the Huntington's disease gene.

The quest for the mutation responsible for Huntington's disease (HD) has required an exceptionally detailed analysis of a large part of 4p16.3 by molecular genetic techniques, making this stretch of 2.2 megabases one of the best characterized regions of the human genome. Here we describe the construction of a cosmid and P1 clone contig spanning the region containing the HD gene, and the establishment of a detailed, high resolution restriction map. This ordered clone library has allowed the identification of several genes from the region, and has played a vital role in the recent identification of the Huntington's disease gene. The restriction map provides the framework for the detailed analysis of a region extremely rich in coding sequences. This study also exemplifies many of the strategies to be used in the analysis of larger regions of the human genome.

Base Sequence↗
PubMed1993

Results of percutaneous transluminal coronary angioplasty in women. 1985-1986 National Heart, Lung, and Blood Institute's Coronary Angioplasty Registry.

BACKGROUND: The National Heart, Lung, and Blood Institute (NHLBI) Percutaneous Transluminal Coronary Angioplasty (PTCA) 1978-1981 Registry cohort indicated that PTCA risk was higher and efficacy was lower in women. Data from the 1985-1986 PTCA Registry are used to address the question of whether compared with men, women still have a worse outcome after PTCA. METHODS AND RESULTS: The 1985-1986 NHLBI PTCA Registry collected data on consecutive, first-PTCA cases at 16 centers. Initial results are reported for 2,136 patients, 546 of whom were women. Four-year follow-up status was available on 95% of the cohort. Although women were an average of 4.5 years older than the male patients and had more cardiovascular risk factors and more severe angina, their coronary artery disease as assessed by angiography was not more extensive. Rates of angiographic success on a per-lesion basis were similar for women and men (89% versus 88%), and the clinical success rates (79%) were the same. Women had more initial complications (29% versus 20%, p < 0.001) and a considerably higher procedural mortality rate (2.6% versus 0.3%, p < 0.001). For patients who survived the initial procedure, 4-year survival was similar for men and women. At 4 years, women had slightly fewer events (myocardial infarction, repeat PTCA, and/or coronary artery bypass grafting). Despite the higher proportion of women reporting the presence of angina and medication use at 4 years, the proportion reporting improvement in symptomatic status was similar to that of men. CONCLUSIONS: Women undergoing PTCA have a higher procedural mortality risk than men; this is explained in part by their worse cardiovascular risk factor profile. Otherwise, the success rate and long-term prognosis after PTCA are excellent, and PTCA should be considered for women in need of revascularization.

Aged↗