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Biomedical subjects

C J McCarthy

Publications and source records attributed to C J McCarthy.

At least 19 recordsLinked to original sources
PubMed2004

Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis.

OBJECTIVE: The study aimed to compare the relative effectiveness of providing a home-based exercise programme versus home-based exercise supplemented with an 8-week class-based exercise programme in reducing pain and improving function in patients with knee osteoarthritis. METHODS: Patients (n = 214) with radiologically confirmed knee osteoarthritis were selected. Patients were randomly allocated to either home or home supplemented with class-based exercise programmes. Both groups were given a home exercise programme whilst the supplemented group also attended for 8 weeks of twice weekly knee classes. Assessments of locomotor function, walking pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were made. Assessments were made pre- and post-treatment and also at 6- and 12-month follow-ups. Statistical analysis involved the use of a longitudinal linear model ANCOVA with baseline values entered as a covariate. RESULTS: Patients from the class-based group demonstrated significantly greater improvement in locomotor function (-3.7 seconds; 95% C.I. -4.9 to -2.5) and decrease in walking pain (-15 mm; 95% C.I. -20 to -11) than the home-based group, at 12-months follow-up. CONCLUSIONS: The supplementation of a home based exercise programme with a class-based exercise programme led to clinically significant superior improvement. These improvements were still evident at 12-month review. This is the first trial to evaluate this common physiotherapeutic practice, and based on this evidence, supplementation of home exercises with a class-based exercise programme can be recommended to patients, clinicians and service providers.

Analysis of Variance↗
PubMed2004

The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee.

OBJECTIVES: The aggregated locomotor function (ALF) score, a simple measure of observed locomotor function, using timed walking, stairs and transfers, was developed and evaluated for intra-tester reliability, criterion-related validity and responsiveness in a sample of patients with knee osteoarthritis. METHODS: Patients with knee osteoarthritis (n = 214) were recruited for inclusion in a randomized controlled trial investigating two methods of exercise provision. Before treatment, patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 36 health survey (SF-36) questionnaires and were timed whilst performing an 8 m walk, ascending and descending a set of gymnasium stairs and completing a test of transferring in and out of a chair. A group of 15 patients also undertook a replicate test-retest reliability study of the above outcome measures. Standardized response means were calculated for the ALF, WOMAC and SF-36 from data from the clinical trial. RESULTS: The ALF takes 10 min to administer and demonstrated excellent intra-tester reliability, with excellent intra-class correlation coefficient (ICC) statistics (ICC(2,k) 0.99; 95% CI 0.98-0.99), and low standard error of measurement (0.86 s) and smallest detectable difference (9.5%) values. Criterion-related validity with the physical function dimensions of the WOMAC and SF-36 was good, with correlation coefficients of 0.59 and - 0.53 respectively. Standardized response means were higher for the ALF (0.49) than for both the WOMAC (0.39) and the SF-36 (0.12). CONCLUSIONS: This work has demonstrated that the ALF can be used as a measure of physical function status and as a means of quantifying treatment response. The measure offers a simple and convenient outcome in the assessment and treatment of locomotor dysfunction. The ALF score is a reliable, valid and responsive outcome measure over 12 months and can be recommended for use in the evaluation of patients with knee osteoarthritis.

Aged↗
PubMed2004

Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.

OBJECTIVES: To establish the relative effectiveness and cost of providing a home-based exercise programme versus home-based exercise supplemented with an 8-week class-based exercise programme. DESIGN: The trial was a pragmatic, single-blind randomised clinical trial accompanied by a full economic evaluation. SETTING: Patients were randomly allocated to either home-based exercise or home exercise supplemented with class exercise programmes. PARTICIPANTS: A total of 214 patients, meeting the American College of Rheumatology's classification of knee osteoarthritis, were selected from referrals from the primary and secondary care settings. INTERVENTIONS: Both groups were given a home exercise programme aimed at increasing lower limb strength, and endurance, and improving balance. The supplemented group also attended 8 weeks of twice-weekly knee classes run by a physiotherapist. Classes represented typical knee class provision in the UK. MAIN OUTCOME MEASURES: Assessments of locomotor function, using a timed score of three locomotor activities, walking pain and self-reported disability with the Western Ontario and McMaster's Universities osteoarthritis index (WOMAC) were made. General health, lower limb strength, range of movement and compliance with exercise were also measured. Patients were assessed before and after treatment, and also at 6- and 12-month follow-ups. The economic evaluation looked at health service resource use and assessed cost-effectiveness by relating differential costs to differences in quality-adjusted life-years (QALYs) based on patients' responses to the EuroQol-5 Dimensions. Data were obtained at baseline, 1 month, 6 months and 12 months through face-to-face interviews and, where appropriate, examination of hospital medical records. RESULTS: Patients from the supplemented group demonstrated significantly greater improvement in locomotor function and decrease in pain while walking at all follow-ups. The supplemented group also demonstrated smaller but significant improvements in balance, strength, WOMAC score, and the physical function and pain dimensions of the Short Form-36. However, not all of these improvements were maintained over the 12-month follow-up period. There was no evidence that compliance with the home exercise programme was different or that total costs or mean QALY gains were significantly different between the groups. However, costs were slightly lower and QALY gains slightly higher in the group with the supplementary class-based programme. The economic evaluation suggests that supplemented programmes are likely to be considered cost-effective, although there is uncertainty around this estimate, with approximately 30--35% probability that the intervention would not be cost-effective. CONCLUSIONS: The supplementation of a home-based exercise programme with a class-based exercise programme led to superior improvement in the supplemented group. These differential improvements were still evident at review 12 months after treatment had ceased. The additional cost of the supplemented group was offset by reductions in resource use elsewhere in the system. Compliance with the home exercise programme did not differ between the groups. Based on this evidence, the supplementation of a home-based exercise programme with an 8-week class-based exercise programme can be confidently expected to produce small improvements in locomotor function and clinically important reductions in pain. It is recommended that future research investigates methods of increasing compliance with home exercise programmes and evaluates the impact of these interventions in the primary care setting, where most patients with knee osteoarthritis are managed.

Aged↗
PubMed2001

Electromyographic fatigue characteristics of the quadriceps in patellofemoral pain syndrome.

This study compared the fatigue characteristics of the vastus medialis oblique (VMO), vastus lateralis (VL) and rectus femoris (RF) muscles. Ten healthy subjects with 10 patients with patellofemoral pain syndrome (PFPS) performed an isometric leg press for 60 seconds at 60% MVIC with data collected using surface EMG. The power spectrum was analyzed and the extracted median frequency normalised to calculate a linear regression slope for each muscle. A repeated measures ANOVA revealed no significant differences, neither between the groups (P=0.592) nor the muscles (P=0.434). However, the slopes for the VMO and VL were different between the two groups with similar slopes for the RF. There was much larger variability of MF values in the PFPS group. The VMO:VL ratio calculated from these slopes for the healthy subjects was 1.17 and for the PFPS group was 1.78. These results may indicate unusual features in the fatigue indices of the quadriceps in PFPS.

Adult↗
PubMed2001

Spinal manipulative thrust technique using combined movement theory.

Spinal Manipulative Thrust Technique (SMTT) is employed by all manual therapy professions using different rationales for the selection of technique. A method of rationally selecting particular SMTT's is described with a view to integrating SMTT into the practice of manual therapists familiar with Combined Movement Theory (CMT), a corollary of the Maitland Concept. The similarities of CMT and SMTT methodologies are described and two examples of how CMT can be utilized for SMTT selection in the cervical spine are detailed.

Contraindications↗
PubMed2000

The reproducibility of multi-joint isokinetic and isometric assessments in a healthy and patient population.

DESIGN: Test re-test reliability design. OBJECTIVE: To determine a reproducible protocol for lower limb simultaneous multi-joint assessments on a healthy group of subjects and a patient group with patellofemoral pain syndrome. BACKGROUND: Although single joint assessment with isokinetic dynamometers has been utilised for many years in knee rehabilitation, simultaneous multi-joint assessment has not attracted comparable attention. METHODS: Twenty healthy volunteers mean age 30.6 years and 16 patients with patellofemoral pain syndrome mean age 29.6 years performed isometric maximum voluntary contractions and concentric isokinetic contractions of the lower limb. Data were collected on three separate days for resultant extension/flexion peak torque, average power and total work which were analysed using intraclass correlation coefficients with a 95% level of confidence. RESULTS: In healthy subjects, intraclass correlation coefficients estimates were > or =0.75 for isokinetic peak torque and >0.83 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.82. In the patient group, intraclass correlation coefficients estimates were >0.82 for isokinetic peak torque and > or =0.75 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.89. Discarding the first session's data for both groups improved the intraclass correlation coefficients estimates for virtually all assessments. CONCLUSIONS: This study has demonstrated high reproducibility of lower limb multi-joint testing for peak torque, average power, and total work on healthy subjects and then has employed the protocol to demonstrate similarly high reliability on a patient group. It has also highlighted the need for a practice session before the data can be said to be reliable. RELEVANCE: Reliability studies often use healthy subject groups, which although useful, have limited relevance to patient populations. This study has not only gained comprehensive reproducibility data on multi-joint assessment in healthy subjects, it has also shown that multi-joint testing can be used safely and reliably in patients with patellofemoral pain syndrome. Clinicians may now be able to measure objectively lower limb function in this patient group both pre and post treatment.

Adult↗
PubMed1999

Cyclooxygenase-2 expression in gastric antral mucosa before and after eradication of Helicobacter pylori infection.

OBJECTIVE: Helicobacter pylori (H. pylori) causes chronic gastritis. The inducible prostaglandin synthetase cyclooxygenase 2 (COX-2) plays an important role in inflammatory conditions. We hypothesized that H. pylori-associated chronic gastritis would express COX-2 protein. Our aim was to evaluate the effect of eradication of H. pylori infection on COX-2 expression in the antral mucosa of patients before and after antibiotic therapy. METHODS: Tissues were obtained from patients with non-ulcer dyspepia undergoing H. pylori eradication. Ten patients with proven H. pylori infection and subsequent successful eradication were studied. Three biopsies of antral mucosa were evaluated before and after H. pylori eradication. The amount of acute and chronic inflammation was quantitated. Immunohistochemical staining for COX-2 was expressed as a percentage of the total number of cells and correlated with the degree of chronic inflammation. RESULTS: Specific immunostaining for COX-2 was observed in antral mucosa of patients infected with H. pylori. Patchy cytoplasmic staining was seen in surface epithelial cells and strong cytoplasmic staining for COX-2 was seen in parietal cells. Spotty cytoplasmic staining for COX-2 was also seen in lamina propria plasma cells, as well as there being macrophages present in the germinal centers of lymphoid aggregates. COX-2 expression could be detected both before and after eradication of H. pylori. The mean percentage of cells staining for COX-2 was significantly higher in H. pylori-infected mucosa, compared with mucosa after successful H. pylori eradication (33.4% +/- 5.4 vs 18.9% +/- 3.3, p = 0.038). COX-2 immunostaining correlated best with the chronic inflammation score (r2 = 0.78, p < 0.001). There was a strong correlation for those subjects who were H. pylori infected, as well as for those who had successful H. pylori eradication. CONCLUSIONS: H. pylori associated acute and chronic antral inflammation was associated with immunohistochemical detection of COX-2 protein in epithelial cells, in addition to associated mononuclear cells and parietal cells. Expression was reduced, but not eliminated, in the epithelium after successful eradication of H. pylori. Despite the reduction in COX-2 expression after H. pylori eradication, expression of COX-2 in epithelial cells remained and strongly correlated with the extent of the chronic inflammatory cell infiltrate. The clinical implications of H. pylori-associated induction of COX-2 expression for patients on selective COX-2 inhibitors, in addition to the role of COX-2 in gastric carcinogenesis, deserve further study.

Acute Disease↗
PubMed1998

Cytogenetic abnormalities and therapy-related myelodysplastic syndromes in rheumatic disease.

OBJECTIVE: To describe the myelodysplastic syndromes (MDS) and cytogenetic abnormalities that occur in patients who have been treated with alkylating drugs for their rheumatic disease. METHODS: Patients with rheumatic disease who developed MDS after current or previous treatment with alkylating drugs were selected for evaluation by chart review and cytogenetic studies. RESULTS: Eight patients with rheumatic disease (mean age 56.9 years) developed MDS over the study period. Seven had received oral cyclophosphamide and 1 chlorambucil as their main immunosuppressive drug. The mean total cumulative dose of cyclophosphamide or chlorambucil was 118 gm and 6.5 gm, respectively, over a period of 2-10 years. The cytogenetic abnormalities included a deletion of all or part of chromosome 7 in 5 patients, while 4 had a deletion of part of the long arm of chromosome 5. Six of the patients have since died. CONCLUSION: Large cumulative doses of cyclophosphamide and chlorambucil were associated with the development of MDS, the occurrence of abnormalities of chromosome 5 and/or chromosome 7 deletions, and a poor prognosis.

Adult↗
PubMed1997

Involvement of nuclear factor kappa B in the regulation of cyclooxygenase-2 expression by interleukin-1 in rheumatoid synoviocytes.

OBJECTIVE: To evaluate involvement of the transcription factor nuclear factor kappa B (NF-kappa B) in the increased expression of cyclooxygenase-2 (COX-2) stimulated by interleukin-1 beta (IL-1 beta) in primary rheumatoid synoviocytes. METHODS: We treated early-passage rheumatoid synoviocytes with IL-1 beta and examined the time course of NF-kappa B translocation to the nucleus by Western blot analysis, as well as NF-kappa B binding to the COX-2 promoter/enhancer by electrophoretic mobility shift assay. We correlated the time course of NF-kappa B binding with expression of COX-2 messenger RNA (mRNA) and protein. Synoviocytes were then treated with either sense or antisense phosphorothioate-modified oligonucleotides derived from the transcription start site of the human NF-kappa B p65 RNA. We analyzed NF-kappa B binding to the COX-2 promoter and COX-2 protein levels after these treatments. RESULTS: IL-1 beta rapidly stimulated the translocation of the p65, p50, and c-rel NF-kappa B subunits from the cytoplasm to the nucleus. Electrophoretic mobility shift assay demonstrated binding to 2 NF-kappa B sites within the COX-2 promoter/enhancer, with a time course identical to that of nuclear localization of NF-kappa B. Supershift analysis revealed that binding activity was due primarily to the p65-p50 heterodimer and the p50 homodimer. With appropriate lag time after NF-kappa B binding, COX-2 mRNA and protein were increased. Pretreatment of RA synoviocytes with NF-kappa B p65 antisense oligonucleotides resulted in decreased binding to the COX-2 promoter and decreased COX-2 protein expression. CONCLUSION: These data demonstrate that signaling via the NF-kappa B pathway is involved in regulation of COX-2 expression induced by IL-1 beta in RA synoviocytes.

Arthritis, Rheumatoid↗
PubMed1996

Power Doppler sonography of synovitis: assessment of therapeutic response--preliminary observations.

Power Doppler sonography was used in eight symptomatic knees in seven patients with arthritis before and after joint aspiration and intraarticular administration of steroids. A qualitative decrease in synovial perfusion was observed in all eight knees, and symptoms improved in seven of the eight cases. These preliminary data suggest a role for power Doppler sonography in assessment of serial changes in synovial inflammation.

Adult↗
PubMed1995

Chemical gastritis induced by naproxen in the absence of Helicobacter pylori infection.

AIM: To evaluate the histological changes that occur in the antral mucosa of healthy male subjects before and after one week of naproxen administration, using a chemical gastritis score according to the Helicobacter pylori status. METHODS: Nineteen male subjects (mean age 31 years) underwent two endoscopies: one before and the other after one week of naproxen treatment (1 g daily). Antral biopsy specimens were assessed for the presence of H pylori infection and for chemical gastritis, defined as the presence of foveolar hyperplasia, muscle fibres in the lamina propria, oedema, and vasodilatation, in the absence of acute or chronic inflammatory cell infiltrate. RESULTS: Of the 19 subjects, eight had H pylori infection. After one week of naproxen treatment, none of those with H pylori infection developed chemical gastritis, while five of 11 (45%) of those without H pylori infection did. In the absence of H pylori infection there was no evidence of inflammation, either before or after naproxen administration. CONCLUSIONS: A different pattern of antral histological change occurs following naproxen administration. This pattern is related to the presence or absence of H pylori infection, suggesting that H pylori status should be determined in histological studies of subjects taking non-steroidal anti-inflammatory drugs.

Adult↗
PubMed1995

Early ultrastructural changes of antral mucosa with aspirin in the absence of Helicobacter pylori.

AIMS: To describe the ultrastructural changes that occur in human antral mucosa following direct application of aspirin in volunteers without Helicobacter pylori infection. METHODS: Ten healthy male volunteers without H pylori infection underwent three consecutive endoscopies (at zero, one and five hours). At the first endoscopy, two biopsy specimens were obtained (one for histology and the other for electron microscopy (EM)). At subsequent endoscopies, a single biopsy specimen was obtained for EM. A 50 ml solution of aspirin (concentration 3 mg/ml) was applied to the antral mucosa at the first endoscopy in five subjects; the other five subjects received 50 ml distilled water (placebo). RESULTS: The ultrastructural appearance of the first biopsy specimen in all subjects and subsequent biopsy specimens in the placebo treated subjects was normal. The aspirin treated group had evidence of intercellular oedema, widening of capillary fenestrae, rupturing of apical membranes, and dilatation of endoplasmic reticulum and mitochondria after one hour; these changes were more marked at five hours. Tight junctions were maintained. CONCLUSION: This is the first study to describe the early ultrastructural changes in antral mucosa induced by aspirin in subjects without H pylori infection.

Adult↗
PubMed1993

Treatment of rheumatoid hand synovitis with a regional block technique.

This study reports a novel technique for treating painful rheumatoid hand synovitis using a regional block technique. Nine patients with symptomatic rheumatoid hand synovitis were treated. Assessments of symptoms, grip strength and synovial swelling were made in each hand before the injection, and at 1 and 4 weeks after the procedure. A sphygmomanometer cuff was inflated, on the side of the patients most symptomatic hand, to 220mmHg and a solution of hydrocortisone sodium succinate 50mgs and lignocaine 10mls 0.5% was injected intravenously. The cuff was deflated slowly after 20 minutes. The injected hand improved symptomatically in 7 patients at 1 week, and further improvement was reported in 6 of these 7 at 1 month. Mean grip strength increased significantly in the injected hand both at 1 week (p = 0.01) and 1 month (p = 0.018). There was no change in the other hand. This technique is safe, reduced hand pain and improved grip strength in these patients with rheumatoid hand synovitis.

Arthritis, Rheumatoid↗
PubMed1993

Short report: treatment of Helicobacter pylori-associated duodenal ulcer with omeprazole plus antibiotics.

Omeprazole heals most duodenal ulcers after 4 weeks of treatment but relapse is common. Eradication of Helicobacter pylori is associated with reduced rate of ulcer relapse. This study investigates the effect of omeprazole with antibiotics in H. pylori-associated duodenal ulceration. Forty-three patients with endoscopically proven duodenal ulcer and H. pylori entered this study. Treatment consisted of 20 mg omeprazole daily (four weeks) and seven days (first week) treatment with 400 mg metronidazole t.d.s. and 500 mg tetracycline t.d.s. Four weeks after completing the treatment, 81% (35/43) had a healed duodenal ulcer, and 58% (25/43) had H. pylori eradication. In those who healed, at one year 21 remained H. pylori-negative, 12 had persistent H. pylori infection and 2 had re-infection. The ulcer relapse rate at one year was 26%: of the 9 who relapsed, 6 had persistent infection, 2 were re-infected, and only 1 was H. pylori-negative. This combination therapy of antibiotics with omeprazole successfully eradicates Helicobacter pylori and has a lower ulcer relapse than omeprazole alone.

Adult↗