Biomedical subjects
Publications and source records attributed to S Marks.
We describe five babies, who were exclusively breast fed, with life-threatening complications of hypernatraemic dehydration secondary to inadequate breast feeding. An increased awareness among health professionals is required so that this potentially devastating condition can be prevented.
AIM: The aim of this study is to compare the effect of orlistat vs. placebo on the predicted 10-year cardiovascular disease (CVD) risk in obese people with one or more cardiovascular risk factors treated for 12 months, in conjunction with a fat-reduced, but otherwise ad libitum, diet. METHODS: A double-blind, randomized, placebo-controlled, parallel study was performed in conjunction with a fat-reduced diet and physical activity advice for 1 year. Participants (n = 339) from eight centres in Australia and New Zealand were randomized to either orlistat (120 mg) three times daily (n = 104 women, 66 men; mean +/- s.d. age = 52.0 +/- 7.5 years, body mass index (BMI) = 37.6 +/- 5.1 kg/m(2)) or placebo three times daily (n = 89 women, 80 men; age = 52.5 +/- 7.4 years, BMI = 38.0 +/- 4.9 kg/m(2)). The primary efficacy criterion was the 10-year risk of developing CVD calculated from the Framingham equation. Secondary efficacy criteria were body weight, waist circumference, blood pressure and serum concentrations of triglycerides, cholesterol (total, LDL and HDL), glucose, insulin and glycated haemoglobin and quality of life. RESULTS: There was no difference in the change in 10-year CVD risk between orlistat and placebo groups over 1 year. The orlistat group, however, had significant favourable changes in many of the individual CVD risk factors (total cholesterol, LDL-cholesterol, glucose, glycated haemoglobin, insulin, body weight and waist circumference) and one of the domains of quality of life measured by means of the SF-36 questionnaire (vitality), compared to the placebo group. Significant reductions in medication use for hypertension and diabetes were observed in the orlistat group, compared to those in placebo, but there were no significant differences in medication use for blood lipids. CONCLUSIONS: Orlistat may have reduced CVD risk, as judged by the favourable changes in individual risk factors and reductions in medication use, but the method used in order to measure absolute CVD risk in this study (Framingham CVD equation) was not sensitive enough to detect the changes in this relatively low-risk group (approximately 10% of risk of a CVD event over 10 years).
A new X-ray undulator has been designed and constructed which produces linearly polarized X-rays in which the plane of polarization can be oriented to a user selectable angle, from horizontal to vertical. Based on the Apple-II elliptically polarizing undulator (EPU), the undulator rotates the angle of the linear polarization by a simple longitudinal motion of the undulator magnets. Combined with the circular and elliptical polarization capabilities of the EPU operating in the standard mode, this new undulator produces soft X-ray radiation with versatile polarization control. This paper describes the magnetic structure of the device and presents an analysis of the magnetic field with varying undulator parameters. The variable linear polarization capability is then exhibited by measuring the X-ray absorption spectrum of an oriented polytetrafluoroethylene thin film. This experiment, which measures the linear dichroism of the sample at two peaks near the C 1s absorption edge, demonstrates the continuous polarization rotation capabilities of the undulator.
The impact on sediment pollution of environmentally sensitive harvesting of a 15 ha plot (20% of the catchment area) of mature coniferous plantation forest in the 0.89 km2 Afon Tanllwyth catchment, Plynlimon, was investigated for 12 months before harvesting began and a further 18 months after. The results revealed: (a) a steepening of the suspended sediment concentration vs. discharge rating curve resulting in a 39% increase in suspended sediment yield (as compared to the adjacent forested Hafren catchment) during the year in which the harvesting operations took place; (b) a statistically significant increase in main channel bank erosion rates, as compared with the nearby Afon Cyff; main channel banks are estimated to have contributed around 80% of the total catchment suspended sediment yield during the two year period (1995-1996), and (c) no significant change in bedload yields over the duration of the study, though a longer post-harvesting time series of bedload data will be required to properly assess the impact of the harvesting operation upon bedload yields. Forest management implications of these findings are discussed in detail with respect to the existing Forest and Water guidelines.
Much of nursing practice is (and always has been) based on information generated through inquiry. Finding the best answers quickly and effectively for the questions that arise in the clinical setting facilitates care, increases nursing efficiency, and improves patient outcome and satisfaction. Posing clinical questions also can help nurses identify and fill in gaps in knowledge, keep up with advances in clinical practice, and strengthen interactions with their peers, team members, and patients and their families. Formulating clinical questions that lead to sound, evidence-based answers to resolve clinical problems or direct patient-care decisions takes time and practice. The information in this article will assist nurses to develop the skill of framing clinical questions efficiently and effectively.
BACKGROUND: Most antiobesity drugs act centrally to reduce appetite or increase satiety. Orlistat is the first in a new class of drugs targeted at a single dietary component, in this case dietary fat. OBJECTIVE: To review the clinical actions and efficacy of orlistat and to discuss its place in overall weight management. DISCUSSION: Orlistat is best used in long term weight management as an adjunct to dietary modification and increased physical activity. The reduction in fat absorption results in a slow but sustained weight reduction and improved metabolic parameters such as reduced total, and LDL cholesterol. Side effects are minimised by maintaining a low fat diet.
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BACKGROUND: In this study, we review the results of Menière's disease treatment using microdose gentamycin delivered directly to the round window using a new microcatheter system. PATIENTS AND METHODS: 11 patients were treated by 1.25 mg gentamycin on the 3rd and 7th day after insertion of the new microcatheter at the niche of the round window membrane, while a second group of 7 patients was treated by a gentamycin dosage of 1 microliter/h continuously applied by a minipump over a period of 10 days. Electrocochleography was derived by an integrated electrode and the microcatheter was removed after 10 days. The results were analysed with a follow-up ranging from 6 to 12 months. RESULTS: In 15 of 18 patients (83%) tinnitus was improved significantly throughout the follow-up period. Vertigo was eliminated in all patients, and pressure was relieved in 17 of 18 (94%). CONCLUSIONS: These preliminary data suggest that gentamycin delivered by the Round-Window-Microcatheter is a safe and effective treatment for the reduction of tinnitus, vertigo, and pressure associated with Menière's disease.
Interleukin-15 (IL-15) is a pleiotropic cytokine that induces the generation and differentiation of lymphoid cells and shares many biological activities with IL-2. We have shown here the development of dendritic cells (DC) from human CD34+ hemopoietic precursor cells cultured for 2-4 weeks with IL-15 alone. DC generated with IL-15 have typical morphological, immunocytochemical, phenotypic, and functional characteristics of mature DC. Dual flow cytometry analysis performed weekly demonstrated increasing co-expression of CD1a or CD83 with HLA-DR, CD80, CD86, IL-2R alpha, beta, and gamma. Two populations of cells were distinguished among CD34+ progeny. Small and medium-size cells were mainly natural killer (NK) cells (72.6-85.2% CD56+) and low numbers of DC (9.1-21.3% CD1a+). Large cells were mostly DC (75.4-95.4% CD1a+). Isolated CD34+ cells did not express IL-2R subunits but after 2-3 days in culture with IL-15, they were found to express IL-2Rgamma. Induced expression of IL-2Rgamma on CD34+ cells may explain the primary mechanism of IL-15-regulated differentiation of hemopoietic precursor cells. Thus, our data suggest that IL-15 stimulates CD34+ cells to differentiate into NK and DC and may represent a new growth and survival factor for lymphoid DC.
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CONTEXT: Resistance to most or all cephalosporin antibiotics in Klebsiella species has developed in many European and North American hospitals during the past 2 decades. OBJECTIVE: To determine if restriction of use of the cephalosporin class of antibiotics would reduce the incidence of patient infection or colonization by cephalosporin-resistant Klebsiella. DESIGN: A before-after comparative 2-year trial. SETTING: A 500-bed, university-affiliated community hospital in Queens, NY. PATIENTS: All adult medical and surgical hospital inpatients. INTERVENTION: A new antibiotic guideline excluded the use of cephalosporins except for pediatric infection, single-dose surgical prophylaxis, acute bacterial meningitis, spontaneous bacterial peritonitis, and outpatient gonococcal infection. All other cephalosporin use required prior approval by the infectious disease section. MAIN OUTCOME MEASURE: Incidence of patient infection or colonization by ceftazidime-resistant Klebsiella during 1995 (control period) compared with 1996 (intervention period). RESULTS: An 80.1% reduction in hospital-wide cephalosporin use occurred in 1996 compared with 1995. This was accompanied by a 44.0% reduction in the incidence of ceftazidime-resistant Klebsiella infection and colonization throughout the medical center (P<.01), a 70.9% reduction within all intensive care units (P<.001), and an 87.5% reduction within the surgical intensive care unit (P<.001). A concomitant 68.7% increase in the incidence of imipenem-resistant Pseudomonas aeruginosa occurred throughout the medical center (P<.01). All such isolates except one were susceptible to other antibiotics. CONCLUSION: Extensive cephalosporin class restriction significantly reduced nosocomial, plasmid-mediated, cephalosporin-resistant Klebsiella infection and colonization. This occurred at the price of increased imipenem resistance in P aeruginosa, which remained susceptible to other agents. Thus, an overall reduction in multiply-resistant pathogens was achieved within 1 year.
Dendritic cells (DC) have been shown to develop along a myeloid or lymphoid lineage of differentiation propagated from bone marrow or early thymic precursor cells with hematopoietic cytokines. In our study, we have induced growth and differentiation of DC from cord blood CD34+ cells initiated in interleukin-2 (IL-2) alone or in IL-2 + stem cell factor (SCF) + tumor necrosis factor alpha (TNF-alpha)-supplemented medium and cultured with IL-2 or IL-2 + SCF for 28-35 days. Dendritic morphology and antigenic phenotype of DC grown with IL-2 were characteristic for DC cultured in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF). Growth and differentiation of DC was followed by an increase in expression of MHC II and co-stimulating molecules CD80 and CD86. We have also shown the expression of the IL-2 receptor (IL-2R) gamma-chain in CD34+ cells after 2-3 days of culture with IL-2 alone. The co-expression of the IL-2R alpha, beta, and gamma subunits in both DC cultured with IL-2- or GM-CSF-containing cocktail of cytokines was also shown. The time curve for induction of IL-2R demonstrated low levels of subunit expression at the beginning of culture. The number of CD1a cells co-expressing CD25, CD122, and CDgamma increased to about 24-68 and to 78-95% after 21 and 28-35 days, respectively. Development of natural killer cells was shown along with DC. The proportion of CD56+ cells and cytotoxicity increased in a time-dependent manner.
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The purpose of this study was to characterize the reinforcing, subjective and psychomotor effects of nitrous oxide in healthy volunteers with different alcohol histories. Subjects were divided into two groups: light drinkers (n = 9) and moderate drinkers (n = 10). A choice procedure was used in which subjects first sampled placebo and a given concentration of nitrous oxide, and then chose between the two. Nitrous oxide concentration varied across the four-session experiment from 10-40%. Besides choice, subjective and psychomotor effects served as dependent measures. The majority of subjective effects of nitrous oxide, and its psychomotor-impairing effects, did not vary as a function of drinking group. However, a Wilcoxon rank sum test showed that the median number of times moderate drinkers chose nitrous oxide (three) was significantly higher than the median number of times light drinkers chose nitrous oxide (one). This study provides suggestive evidence that the reinforcing effects of nitrous oxide are modulated by alcohol history.
BACKGROUND: Primary malignant neoplasms of the submandibular salivary gland (SMG) are rare, and metastatic tumors are rarer. Most of the metastases are discovered months or years after the diagnosis of the primary malignancy. Despite the increasingly used fine-needle aspiration biopsy (FNAB) in the evaluation of major salivary gland masses, diagnosis of metastases by FNAB has been only rarely studied. CASE: We report a case of lung carcinoma initially presented as a SMG swelling diagnosed by aspiration biopsy. The patient is a 52-yr-old man, a 40-pack/year smoker who also complained of weight loss and blood-streaked cough. An FNAB of the mass was consistent with metastatic adenocarcinoma with prominent signet ring-cell component of unknown primary. Subsequent studies revealed a left lung mass and left pleural effusion. The effusion cytologic examination showed malignant cells consistent with carcinoma. The patient's condition deteriorated rapidly, and he died within a few days. An autopsy revealed adenocarcinoma of lung with prominent signet ring-cell component. CONCLUSION: FNAB is a rapid, safe, reliable, and cost-efficient technique for evaluation of major salivary glands lesions. To our knowledge, this case is the first lung carcinoma presenting as SMG mass initially diagnosed on FNAB.
To report a case in which triphasic waves developed during pentobarbital treatment. Pentobarbital coma is indicated in status epilepticus, refractory to other anticonvulsants, and in certain neurologic conditions in order to decrease brain metabolism. At high doses of pentobarbital, the EEG shows a typical burst-suppression pattern, while at low doses, diffuse slowing. Triphasic waves have not been reported in association with pentobarbital. A 54-year-old female underwent surgery for giant ophthalmic aneurysm clipping. Due to tearing and bleeding of the carotid artery, a clamp was placed, an external-internal carotid artery bypass was done, and the patient was started on pentobarbital. The patient remained comatose, the EEG showed a burst-suppression pattern, and the pentobarbital level was 30.5 micrograms/dl. One week later, the patient was still comatose, the EEG showed generalized triphasic waves with anterior predominance, and the pentobarbital level was 11 micrograms/dl. One day later, the patient was awake, and the EEG was normalized. The patient made a complete recovery. Triphasic waves may be seen in patients on pentobarbital. It is important to recognize this finding in patients on pentobarbital due to status epilepticus. This pattern should not be misinterpreted as 'electrical' status epilepticus.
We describe an Escherichia coli O157:H7 outbreak associated with a fresh water lake at a county park. Campers were surveyed for diarrhoeal illness within 10 days of their visit, and a case-control study of day visitors was conducted. A confirmed case was a symptomatic person with a stool culture positive for E. coli O157:H7 and a probable case was a person with bloody diarrhoea. Clinical isolates of E. coli O157 were subtyped by pulsed field gel electrophoresis (PFGE). In the camper survey, 12 (38%) of 32 swimmers had a diarrhoeal illness (relative risk [RR] = 12.4; 95% confidence interval [CI] = 1.7-89.7). For the case-control study, the 12 cases were more likely than controls to have purposefully ingested lake water (odds ratio [OR] = 6.9, 95% CI = 0.9-55.8). The PFGE patterns of six clinical isolates were indistinguishable. This report further demonstrates that contaminated fresh-water lakes can be the source of community outbreaks of E. coli O157:H7.