Biomedical subjects
Publications and source records attributed to S L Chow.
The final diagnosis of 158 patients who had a cerebrospinal fluid (CSF) lactate concentration greater than 2 mmol/l was ascertained. The conditions included seizures, inflammatory changes, and proven metabolic disorders. For the diagnosis of congenital lactic acidoses, CSF lactate should ideally be measured in a seizure free patient after any acute illness.
At a tertiary referral centre, just over 50% of patients with plasma ammonia values over 200 micro mol/l had inborn errors of metabolism. To distinguish artefactual high values from those requiring treatment, the measurement should be repeated immediately if the result is above 200 micro mol/l and at lower concentrations if the patient is encephalopathic.
Recurrent rhabdomyolysis has previously been reported in one patient with glutaric aciduria type I. We report rhabdomyolysis in a second, unrelated patient, suggesting that there may be a specific association with thismetabolic disorder.
Nitrates and calcium channel blockers (CCBs) have been shown to decrease lower esophageal sphincter pressure and theoretically may precipitate or aggravate gastroesophageal reflux. Thus, the authors hypothesized that patients who receive these agents would have greater use of acid-suppressive drug use, defined as histamine2 antagonists or proton pump inhibitors. A retrospective cohort design was used to assess the use of acid-suppressive drug use in hypertensive patients with respect to both nitrates and antihypertensive therapy. Of 15,662 treated hypertensive patients, 20% received acid-suppressive therapy. An increased use of acid-suppressive therapy was associated with nitrate (odds ratio [OR] = 1.71), CCB (OR = 1.46), and alpha 1 antagonist (OR = 1.32) treatment, which appeared to be additive when patients received two or more of the agents. Within the class of CCBs, there was no significant difference among the individual agents. As the clinical and economic burden may be substantial, further study is warranted.
The null-hypothesis significance-test procedure (NHSTP) is defended in the context of the theory-corroboration experiment, as well as the following contrasts: (a) substantive hypotheses versus statistical hypotheses, (b) theory corroboration versus statistical hypothesis testing, (c) theoretical inference versus statistical decision, (d) experiments versus nonexperimental studies, and (e) theory corroboration versus treatment assessment. The null hypothesis can be true because it is the hypothesis that errors are randomly distributed in data. Moreover, the null hypothesis is never used as a categorical proposition. Statistical significance means only that chance influences can be excluded as an explanation of data; it does not identify the nonchance factor responsible. The experimental conclusion is drawn with the inductive principle underlying the experimental design. A chain of deductive arguments gives rise to the theoretical conclusion via the experimental conclusion. The anomalous relationship between statistical significance and the effect size often used to criticize NHSTP is more apparent than real. The absolute size of the effect is not an index of evidential support for the substantive hypothesis. Nor is the effect size, by itself, informative as to the practical importance of the research result. Being a conditional probability, statistical power cannot be the a priori probability of statistical significance. The validity of statistical power is debatable because statistical significance is determined with a single sampling distribution of the test statistic based on H0, whereas it takes two distributions to represent statistical power or effect size. Sample size should not be determined in the mechanical manner envisaged in power analysis. It is inappropriate to criticize NHSTP for nonstatistical reasons. At the same time, neither effect size, nor confidence interval estimate, nor posterior probability can be used to exclude chance as an explanation of data. Neither can any of them fulfill the nonstatistical functions expected of them by critics.
OBJECTIVE: Simethicone, which is a principal ingredient in the defoaming agent used during gastroscopy, can inhibit the growth of Helicobacter pylori (MIC, 64-128 mg/l). This prospective study was designed to evaluate the in vivo and in vitro effects of simethicone on the accuracy of the rapid urease test (RUT). METHODS: In the in vivo study, three sets of gastric biopsies (two from the antrum, and one from the corpus) were taken from 75 patients. The first set was examined histologically, and the second set was used for the RUT (pre-simethicone RUT). Then, 25 ml simethicone (1200 mg/l) was introduced into the stomach for a contact time of 1 min. A third set of gastric biopsies was taken for the RUT (post-simethicone RUT). In the in vitro clinical study, 41 patients were recruited. The first set of gastric biopsies was used for the RUT (pre-incubation RUT). The second set was incubated in 1 ml of simethicone for 5 min before being used for the RUT (post-incubation RUT). In the spectrophotometric study, urease activity before and after incubation in simethicone for 5 min was quantified in 12 patients by measuring the absorbance at 560 nm. RESULTS: Reading at 15 min, the concordance rate between the pre-simethicone and post-simethicone RUT was 98%. In the in vitro clinical study, the concordance rate between the pre-incubation and post-incubation RUT was 97%. The spectophotometric study showed a significant reduction of 43% in urease activity after incubation in simethicone. CONCLUSION: The application of a defoaming agent containing simethicone does not affect the accuracy of the RUT. However, simethicone modestly suppresses urea hydrolysis.
Primary amyloid light chain (AL) amyloidosis of the heart is a rare cause of congestive heart failure. Approximately 15% of patients with primary AL amyloidosis demonstrate no monoclonal proteins on serum or urine immunoelectrophoresis:(so-called nonsecretory immunoglobulin-derived amyloidosis). The histologic findings of endomyocardial biopsy from these patients may be indistinguishable from those with senile cardiac amyloidosis. However, the AL type may respond favourably to chemotherapy while the latter type does not. The prognosis is also better in the senile cardiac amyloid type. The precise diagnosis in the present case was made by applying immunohistochemical techniques on cardiac tissues.
Candida glabrata is a yeast which is considered to be a commensal of the vagina with limited pathogenicity in the immunocompetent host. We report 2 cases of severe chorioamnionitis occurring in pregnancies achieved by in vitro fertilization techniques which resulted in preterm delivery and pregnancy loss. Candida glabrata as the causative agent was probably introduced into the uterus by the cannula at the time of embryo transfer. It is recommended that appropriate investigation of the microbial flora of the cervix be undertaken and treatment instituted prior to embryo transfer in order to prevent this complication.
The overall apparent first-order rate constants (Kab) of small intestinal absorption of sulfadiazine were determined in rats in situ at various pHs (4.01-7.42) of the recirculation fluids at 32 degrees. The purpose of the study was to verify our hypothesis that the rate-determining step for the absorption of sulfonamides involves the formation of an "activated complex" consisting of a transient association of the sulfonamide molecules with the surface protein of the microvillus membrane. The Kab versus Fu (where Fu is the fraction of un-ionized sulfadiazine at a given pH) profile prepared according to the equation Kab = Ki+Fu(Ku-Ki), where Ki and Ku are the first-order rate constants of absorption of the ionized and un-ionized species, respectively, was clearly resolvable into two linear segments: one based on the data in the 4.01-6.43 pH range and the other based on the data in the 6.43-7.42 pH range. In view of the fact that the combined molar concentration of aspartic acid and glutamic acid in the microvillus membrane protein is about twice that of arginine and lysine, the resolution of the data into two linear segments suggested that the negative charge density of the microvillus surface membrane protein in the 6.43-7.42 pH range is greater than that in the 4.01-6.43 pH range. The Ku and Ki values of sulfadiazine were determined in each pH range. It was noted that Ku was greater than Ki in each pH range, and that Ki in the 4.01-6.43 pH range was greater than that in the 6.43-7.42 pH range.(ABSTRACT TRUNCATED AT 250 WORDS)
Using a signal-detection task, the generality of Turvey's (1973) onset-onset rule was tested in our experiments. After seeing, in succession, (1) one or two letters (target display), (2) a multiletter detection display, and (3) a mask display, subjects decided whether or not the letter or letters in the target display reappeared in the succeeding detection display at different levels of detection-display duration in various situations. The subjects' sensitivity was inconsistent with the onset-onset rule. More specifically, sensitivity increased with increases in display duration within a fixed stimulus onset asynchrony of 150 msec. Display duration, however, had no effect on response bias. Nor was there any interaction between display duration and display size in terms of either sensitivity or response bias. The more complicated relationship between display duration and display size does not invalidate the departure from the onset-onset rule.
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A recirculation technique was used to study the first-order kinetics of intestinal absorption of un-ionized sulfadiazine, sulfamerazine, and sulfamethazine in rats in situ at 32, 35, and 38 degrees C. The absorption rate constant (Kab) of each sulfonamide increased with increase in temperature and, at each temperature, Kab was the highest for sulfamethazine and the lowest for sulfadiazine. Applying the activated complex formation theory, the energy of activation (Ea), free energy of activation (delta F*), enthalpy of activation (delta H*), and entropy of activation (delta S*) of absorption were determined for the sulfonamides to gain some insight into the mechanism of their intestinal absorption. The high values of delta F* indicated that the barrier for sulfonamide absorption was great. For each drug, the value of delta H* was positive and that the delta S* negative. However, delta H* and delta S* were the highest for sulfamethazine and the lowest for sulfadiazine, thus revealing the influence of hydrophobic bonding in increasing Kab of the sulfonamides with the increase in methyl group content of their molecules. By considering the facts that (1) the microvillus membrane of the intestinal absorptive cells regulates the rate of passive absorption of drugs, (2) the microvillus membrane is rich in proteins, which are located external to the membrane and exposed to the intestinal fluid, and (3) hydrophobic bonding contributes to the activation parameters of absorption, it was postulated that the activated complex formed in the absorption process consisted of a transient association of the sulfonamide molecules with some protein component of the microvillus membrane.
This paper presents an approach for the establishment of a parametric model of knee joint prosthesis. Four different sizes of a commercial prosthesis are used as an example in the study. A reverse engineering technique was employed to reconstruct the prosthesis on CATIA, a CAD (computer aided design) system. Parametric models were established as a result of the analysis. Using the parametric model established and the knee data obtained from a clinical study on 21 pairs of cadaveric Asian knees, the development of a prototype prosthesis that suits a patient with a very small knee joint is presented. However, it was found that modification to certain parameters may be inevitable due to the uniqueness of the Asian knee. An avenue for rapid modelling and eventually economical production of a customized knee joint prosthesis for patients is proposed and discussed.
A theoretical formula for calculation of peak dP/dt was derived using parameters obtained from continuous wave Doppler echocardiography signals of aortic blood flow. The direct proportional relationship between the main variables of this formula and invasively measured peak dP/dt was validated in 20 patients undergoing routine diagnostic cardiac catheterization. Doppler signals of aortic flow were obtained simultaneously to invasive pressure recordings with a 2 MHz continuous wave transducer via the suprasternal echocardiographic window. The Doppler signals were recorded on magnetic tape and measurements were made with digital calipers by two independent, blinded observers. The following parameters were measured: peak velocity (V) and time from onset of ejection to peak velocity (T). V2/T, the variable of the derived formula, was calculated for each of the observer's measured parameters and showed a very high interobserver correlation. The two observers' measurements of each parameter were averaged for each patient and the resulting mean was used in calculating the V2/T and mean acceleration. 4. A good correlation of V2/T with invasively measured peak dP/dt was obtained. Our derived index of left ventricular function showed a higher correlation with peak dP/dt compared to other Doppler indices of ventricular function. V2/T may provide a noninvasive method for estimating peak dP/dt.
Selective recall of a subset of letters from a multiletter array declines systematically with increases in the delay of the partial report cue. The issues addressed were (a) whether such a decline is due to progressive loss of location information or to systematic loss of features and (b) whether partial report is the result of a select-then-identify or an identify-then-select process. Instructing the subjects to guess or not to guess had an effect of intra-array, displacement, and extra-array errors. Emphasizing on recall location affected both intra- and extra-array errors. The interstimulus interval manipulation had an effect on extra-array errors as well as on intra-array errors. These observations are contrary to the suggestions that intra-array errors are due to loss of location information and that extra-array errors are indicative of a joint effect on misidentification due to chance and the ratio of extra-array errors to intra-array errors. Some other results are difficult for a dual-buffer model but can readily be accounted for by the orthodox view of the iconic store.
Up to 20% of patients undergoing successful coronary angioplasty have been shown to have a mild elevation of creatine kinase-MB (CK-MB). The purpose of this study was to investigate the relationship between clinical and angioplasty procedural variables and circulating markers for cardiac injury. We measured both CK-MB and totally cardiac-specific troponin inhibitory protein (Tn-I) in 22 patients immediately before and at an average time of 10 h 36 min following successful angioplasty. Of these patients 16 had stable angina, six had unstable angina and none had recent myocardial infarction. Four patients had minor complications associated with the procedure (prolonged chest pain, limited coronary artery dissection) but none of these patients had increases in either CK-MB or Tn-I. In two patients there was a mild increase in enzyme-activity assayed CK-MB but none of the 22 patients had significant elevation of mass-assayed CK-MB or cardiac-specific Tn-I. This study supports the view that no significant myocardial damage occurs as a result of successful coronary angioplasty irrespective of the stability of the coronary artery disease. This study confirms the known discrepancies between results obtained by immunoassay and immunoinhibition enzyme assay, due to the false-positive results which can be yielded by the latter technique.
A retrospective study over 15 months showed that 10.7% of primigravid women and 1.6% of multigravid women were delivered by Kielland's forceps: a total of 145 babies. The successful vaginal delivery rate for attempted Kielland's forceps was 96.7%. The neonatal outcome was good and there were no perinatal deaths. Traumatic injuries were present in 7.6% of babies and were minor. The data show that even in the presence of fetal distress, Kielland's forceps can be safely employed for rotational delivery from the mid-pelvic cavity. This approach can avoid some caesarean sections without undue risk to the baby, the caesarean rate being 9.5%. As 10.7% of primigravid women required rotational delivery with Kielland's forceps, it is desirable that primigravid women should be cared for by obstetricians who are skilled in the use of the instrument, in order to maintain a low caesarean section rate in this group, with a good neonatal outcome.
It has been suggested that the systematic decline of partial report as the delay of the partial-report cue increases is due to a time-related loss of location information. Moreover, the backward masking effect is said to be precipitated by the disruption of location information before and after identification. Results from three experiments do not support these claims when new indices of location information and of item information are used. Instead, it was found that the systematic decline in partial report was due to a time-related loss of item information, and location information was affected neither by the delay of the partial-report cue nor by the delay of backward masking. Subjects adopted the "select-then-identify" mode of processing.