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Biomedical subjects

M Winter

Publications and source records attributed to M Winter.

At least 19 recordsLinked to original sources
PubMed2003

The multi-disciplinary evaluation of a national agri-environment scheme.

With an increasing amount of public funds being spent on agri-environmental schemes effective methods have to be developed to evaluate them. As many schemes have multiple objectives there is a need for a multi-disciplinary approach to any evaluation. A method was developed to assess the degree to which ecological, landscape, historical and access objectives for the Countryside Stewardship Scheme (CSS) in England have been met. The method used a sample of 484 agreements for which data were collected from surveys, a desk study and an interview with the agreement holder. These data were then evaluated by an expert team of an ecologist, landscape architect, landscape historian, and a social scientist specializing in rural affairs. The team were subsequently brought together with a Chair to discuss their findings for each agreement, allocating scores for each of five criteria: agreement negotiation; appropriateness, environmental effectiveness, compliance and side effects. The additionality that each agreement was likely to provide was also assessed. The results of this process suggest that in the majority of cases the CSS agreements should maintain or enhance the environment in terms of ecology, landscape, and landscape history and increase public enjoyment of the countryside. Thirty-six percent of agreements showed high additionality and 38% medium additionality which demonstrates that the CSS is likely to provide a benefit to society. Agreement negotiation, predicted environmental effectiveness and predicted compliance all improved significantly over the period 1996-98. Recommendations made from this project have been implemented by the Government department to improve the CSS. The multi-disciplinary method was successful and, with further development, could be used for assessment of any agri-environment scheme, or potentially any conservation project or broader 'rural development' scheme encompassing environmental, economic and social objectives. A key to success is the need for the criteria to be tailored for the project concerned and clearly established at the beginning.

Agriculture↗
PubMed2003

Pilot study of an Internet-based electronic patient treatment record and communication system for haemophilia, Advoy.com.

Communication between patients and haemophilia centres is important in the management of the disease. Traditionally this has been done by paper records which give retrospective and often incomplete data. This paper describes the development and pilot study of a novel Internet-based electronic patient treatment log. The advantages of the system include up to date information available to the haemophilia centre, less data entry, better quality records and an individualized alert system for significant events. The system was tested with ten patients at three UK haemophilia centres and found to be feasible and easy to use. In the opinion of the patients and health care professionals involved in the pilot study, the system improves quality, accuracy, accessibility and usefulness of patient generated data. Development of the system is ongoing and its use extended to other haemophilia centres.

Attitude of Health Personnel↗
PubMed2003

Monocyte activation markers during cardiopulmonary bypass.

Extracorporeal support during cardiac surgery initiates an inflammatory response, causing damage to cardiac, pulmonary and renal tissue [Post Pump Syndrome (PPS)]. This is accompanied by a neutrophil leucocytosis and lymphopenia, but less is known about the role of monocytes and markers of monocyte activity. We studied 19 patients undergoing cardiac surgery, obtaining blood samples from the aortic root (AR) and from the coronary sinus ( < s) before the cardiopulmonary bypass (CPB), 1 min after release of the aortic crossclamp and 10 min after weaning from CPB (periods 1, 2 and 3). Leucocyte count, monocyte count and HLA-DR, CD15, CD11b and CD62L activation markers were measured. In samples obtained from the coronary sinus (CS), HLA-DR, expressed as a percentage of the monocyte count, decreased between periods 1, 2 and 3 by 78%, 66% and 43%, respectively. A similar change was observed in samples from the AR. Conversely, CD62L increased in the CS samples (55%, 68% and 73%), but revealed a lesser increase in the AR samples (51%, 68% and 63%). The other markers showed little change throughout the procedure. Reduced immunological competence could result from the decrease in HLA-DR counts. Increases in CD62L sensitizes monocytes to the tethering effects of endothelial integrins and might contribute to the atherosclerotic process.

Adult↗
PubMed2002

[Findings in a high-risk group following asbestos exposure. Benefit of ENT examinations in patients with long-term exposure to asbestos].

BACKGROUND AND OBJECTIVE: Laryngeal diseases caused by exposure to asbestos are listed in the current German list of occupational diseases under number 4104. Parallel to a multicenter study to evaluate whether a CT scan should be included in the examinations for occupational diseases according to the German surveillance guidelines, an additional ENT examination was evaluated. PATIENTS AND METHODS: One hundred workers with a mean exposure time to asbestos of 20.9 years were given a complete ENT examination in 4 consecutive years (1993-1996). Radiological signs for asbestosis were observed in 21 cases and 58 participants had pleural affections caused by asbestos. Significant nicotine abuse was reported by 15 persons: 61 participants were ex-smokers and 24 had never smoked. Regular alcohol consumption was reported by 90% (11% more than 80 g/day). RESULTS: As documented in the literature, we found a high prevalence of laryngitis, especially in smoking patients. One patient had early laryngeal cancer (T1). CONCLUSION: The integration of an ENT examination into the German surveillance guidelines for occupational diseases should be discussed for patients with a high exposure to asbestos.

Aged↗
PubMed2002

Changes in high molecular weight kininogen levels during and after cardiopulmonary bypass surgery measured using a chromogenic peptide substrate assay.

High molecular weight kininogen (HK) is a co-factor in the blood-contact activation system. A chromogenic peptide substrate assay for HK (HKcs) has been developed in which test plasmas are mixed with diluted HK-deficient plasma and incubated with a soluble contact system activator that activates prekallikrein and factor XII. Calcium chloride, a synthetic thrombin inhibitor and a chromogenic peptide substrate for activated factor X (FXa) are then added. The FXa generated cleaves the FXa substrate releasing p-nitroanaline, which is measured photometrically. Test plasma HK values were calculated from a standard curve generated using a pooled normal plasma. Acceptable intra-assay and inter-assay precision values were obtained and levels of HK up to 200% were measurable. The assay measured HK in plasmas deficient in factor XII, prekallikrein and factor XI, was not affected by antiphospholipid antibodies and gave an acceptable correlation (r = 0.95) when normal plasmas and mixtures of HK-deficient and normal pooled plasma, calculated to give HK levels of 25 and 50%, were compared using HKcs and a HK one-stage clotting assay. The HKcs was used to measure HK levels in seven patients undergoing cardiopulmonary bypass (CPB). HK levels fell significantly during CPB (P = 0.0014) and were significantly higher (P = 0.016) 6 days after CPB, suggesting that HK may be a positive acute-phase reacting protein.

Acute-Phase Proteins↗
PubMed2002

Measurement method for the assessment of transmission properties of implantable hearing aids.

Over the last five years the Symphonix Vibrant soundbridge (VSB), an implantable hearing device, has proven an effective alternative treatment modality for patients suffering from moderate to severe sensorineural hearing loss. The results from the majority of our 40 patients are very encouraging but reveal clinical variations in benefit influenced by the coupling of the transducer to the ossicular chain. This study describes a set-up for measuring the sound pressure level in the external auditory canal when the middle ear implant is activated. The reverse transfer function allows the transducer performance to be determined both intra- and postoperatively. The sound pressure level shows a strong correlation with the stapes footplate displacement and free-field audiometry.

Adult↗
PubMed2002

Antibodies to factor XII are distinct from antibodies to prothrombin in patients with the anti-phospholipid syndrome.

Patients with the anti-phospholipid syndrome (APS) have antiphospholipid antibodies (aPA) which are often targeted towards phospholipid binding proteins such as beta2-glycoprotein I and prothrombin. Antibodies to factor XII (FXIIabs) have also been identified in some patients with APS. Factor XII (FXII) is a member of the kringle family of proteins which include plasminogen and prothrombin. Antibodies to prothrombin have been associated with myocardial infarction and have been shown to cross react with plasminogen. Sixteen patients with APS and FXIIabs were investigated for the presence of antibodies to prothrombin, by enzyme linked immunosorbent assay in a calcium (Ca++) independent assay. All sixteen showed different antibody binding patterns than those observed for antibodies to FXII. Eight patients were further investigated using surface plasmon resonance (SPR) for antibody binding to covalently bound FXII and to covalently bound prothrombin in both Ca++ dependent and independent systems. Of three patients demonstrating antibody binding to FXII by SPR, none demonstrated antibody binding to prothrombin in a Ca++ independent system with one demonstrating antibody binding to prothrombin that was Ca++ dependent. Of five patients who did not bind FXII by SPR, one demonstrated antibody binding to prothrombin in a Ca++ independent system while two demonstrated antibody binding to prothrombin in a Ca++ dependent system. Antibodies to FXII in patients with APS appear to be distinct from antibodies to prothrombin.

Antibody Affinity↗
PubMed2001

Size-selective electrochemical preparation of surfactant-stabilized Pd-, Ni- and Pt/Pd colloids.

A detailed study concerning the size-selective electrochemical preparation of R4N+Br- -stabilized palladium colloids is presented. Such colloids are readily accessible using a simple electrolysis cell in which the sacrificial anode is a commercially available Pd sheet, the surfactant serving as the electrolyte and stabilizer. It is shown that such parameters as solvent polarity, current density, charge flow, distance between electrodes and temperature can be used to control the size of the Pd nanoparticles in the range 1.2-5 nm. Characterization of the Pd colloids has been performed using transmission electron microscopy (TEM), small angle X-ray scattering (SAXS) and X-ray powder diffractometry (XRD) evaluated by Debye-function-analysis (DFA). Possible mechanisms of particle growth are discussed. Experiments directed towards the size-selective electrochemical fabrication of (n-C6H13)4N+Br- -stabilized nickel colloids are likewise described. Finally, a new strategy for preparing bimetallic colloids (e.g., Pt/Pd nanoparticles) electrochemically is presented, based on the use of a preformed colloid (e.g., (n-C8H17)4N+Br- -stabilized Pt particles) and a sacrificial anode (e.g., Pd sheet).

Journal Article↗
PubMed2001

Use of recombinant factor VIIa (NovoSeven) in patients with Glanzmann thrombasthenia.

Recombinant factor VIIa (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) appears effective and relatively safe for the treatment of bleeding and for surgical prophylaxis in patients with Glanzmann thrombasthenia as reported to the International Registry on rFVIIa and Congenital Platelet Disorders. One of the shortcomings of the Registry data is the heterogeneity of treatment protocol, including dosage, number of doses used, duration of treatment before declaration of failure, and mode of rFVIIa administration (bolus v continuous infusion). The data are not yet sufficient to define optimal regimens for various indications such as the type of bleeding or the type of procedures. The place of this drug compared to platelet transfusion in the overall management of patients with Glanzmann thrombasthenia will need to be determined in relationship to a number of challenges and unresolved issues in the clinical care of these patients. These issues include: how to improve local measures for patients with mucosal bleeds, optimal management of young women during menarche, optimal platelet transfusion regimens for various indications, the relationship between antiplatelet antibodies detected by monoclonal antibody-specific immobilization of platelet antigens (MAIPA) and effectiveness of platelet transfusion, whether there are other biological tests that may correlate with effectiveness of platelet transfusion, and management of pregnancy and delivery regarding antiplatelet immunization.

Coagulants↗
PubMed2001

HLA diversity, differentiation, and haplotype evolution in Mesoamerican Natives.

Genetic variation of the Human Leukocyte Antigen region (HLA) in three Amerindian populations from the Southern Mexican state of Oaxaca, the Zapotec, Mixtec and the Mixe is examined. Individuals were typed using PCR-SSOP for four class II loci (DRB1, DQA1, DQB1, DPB1) and three class I loci (HLA-A, -B, and -C). Based on known HLA distributions, European admixture ranged from 1% to 10%. Individuals with European alleles were excluded from subsequent analysis. New alleles were revealed at each of the class I loci. In general, genotype frequencies were in Hardy-Weinberg equilibrium, although some deviations were detected. Allele frequency distributions at the DRB1, DQA1, DQB1 and HLA-A loci in all populations were more even than expected under neutrality, supporting a model of balancing selection at these loci. A history of directional selection for DPB1 in all three populations was indicated, as homozygosity values were significantly above expected values. Allele frequency distributions at HLA-B and HLA-C did not differ significantly from neutrality expectations. The data also provide evidence from linkage disequilibrium that strong haplotypic associations are present across the entire HLA region in each of the populations. Significant overall linkage disequilibrium exists between all pairs of loci typed in these populations, except those which include the DPB1 locus. These associations exist despite the fact that the recombination fraction between HLA-A, in the class I region, and DQB1, in the class II region, may exceed 0.02. One explanation is that selective pressures are maintaining the relationships between particular alleles at these loci in these populations. These relationships are maintained in general across the entire HLA region in the Oaxacan Amerindians, with the exception of DPB1.

Alleles↗
PubMed2001

Kinetics of CFU-Mk after automated plateletpheresis.

BACKGROUND AND OBJECTIVES: Platelet count, thrombopoetin (TPO) level and the compartment of megakaryocyte progenitor cells (CFU-Mk) are major determinants in the regulation of thrombopoiesis. The aim of this study was to investigate the potential changes in the compartment of CFU-Mk and their correlation with serum TPO levels and platelet count after plateletpheresis. MATERIALS AND METHODS: Twelve healthy individuals were randomly assigned to undergo single-donor plateletpheresis. A collagen-based in vitro culture system was used to determine the number of peripheral blood (PB) CFU-Mk before and after donation and on days 1, 4 and 7 thereafter. TPO levels were measured by a specific enzyme-linked immunosorbent assay and whole blood counts were performed using an automated cell counter. RESULTS: The pre-apheresis platelet count (mean +/- SEM: 276 +/- 13 x 10(9)/l) decreased after plateletpheresis to a nadir of 194 +/- 8 x 10(9)/l (P < 0.001), showed a gradual increase on days 1 and 4, and reached pre-apheresis values by day 7 (280 +/- 11). The serum TPO levels were found to be significantly increased on days 1 and 7 as compared to baseline levels (baseline value 103.3 +/- 18.5 pg/ml versus day-1 value 135.8 +/- 25.8 pg/ml and day-7 value 132 +/- 30.19 pg/ml; P < 0.03 and P < 0.03, respectively). The numbers of CFU-Mk in PB were significantly elevated on day 4 only (125 +/- 21 colonies/ml of PB versus pre-apheresis values of 68 +/- 18 colonies/ml of PB, P < 0.005). CONCLUSIONS: These findings suggest that platelet loss during plateletpheresis affects thrombopoiesis at the progenitor cell level, probably through alterations in TPO plasma concentrations.

Blood Cell Count↗
PubMed2001

Antibodies to factor XII and recurrent fetal loss in patients with the anti-phospholipid syndrome.

Forty female patients with either primary anti-phospholipid syndrome (n = 26) or systemic lupus erythematosus (anti-phospholipid syndrome positive) (n = 14) were investigated for levels of factor XII, the presence of lupus anticoagulant and antibodies to cardiolipin, beta 2-glycoprotein I and factor XII. Twenty-one patients had a history of recurrent fetal loss (> 2, mean = 2.6). Lupus anticoagulant positivity showed a weak association with recurrent fetal loss (odds ratio = 1.1). While there was no association between the presence of antibodies to cardiolipin or beta 2-glycoprotein I with recurrent fetal loss, antibodies to factor XII showed a strong and statistically significant association (odds ratio = 5.4, P = 0.025).

Abortion, Habitual↗
PubMed2001

Combination treatment in stable effort angina using trimetazidine and metoprolol: results of a randomized, double-blind, multicentre study (TRIMPOL II). TRIMetazidine in POLand.

AIMS: To assess the antiischaemic efficacy and tolerability of the metabolic agent trimetazidine in combination with metoprolol in patients with stable effort angina. METHODS: This was a randomized, multicentre, double-blind, placebo-controlled parallel group study. A total of 426 male and female patients with stable, effort-induced angina and documented coronary artery disease received either placebo or trimetazidine 20 mg three times daily in addition to metoprolol 50 mg twice daily. Treadmill exercise tests were performed at weeks (-1), 0, 4 and 12. RESULTS: After 12 weeks, there were significantly greater improvements in the metoprolol + trimetazidine group than in the metoprolol + placebo group in: time to 1 mm ST segment depression, total workload, time to onset of angina, maximum ST segment depression, mean weekly number of angina attacks, mean weekly nitrate consumption, and grade of anginal pain. There was no evidence of any development of tolerance to trimetazidine. The tolerability of trimetazidine was excellent. CONCLUSIONS: Therapy with trimetazidine plus metoprolol produced significant improvements in exercise stress tests and the symptoms of angina relative to metoprolol alone. With its metabolic effect, devoid of any haemodynamic action, trimetazidine is useful for combination therapy in patients with stable angina insufficiently controlled by monotherapy with a beta-blocker.

Administration, Oral↗