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Biomedical subjects

J Brand

Publications and source records attributed to J Brand.

At least 19 recordsLinked to original sources
PubMed2005

The treatment of inflammatory arthritis with methotrexate in clinical practice: treatment duration and incidence of adverse drug reactions.

OBJECTIVE: To identify the proportion of patients with inflammatory arthritis who remain on methotrexate in the medium to long term and the incidence of side-effects in clinical practice. METHOD: The study population comprised all patients with inflammatory arthritis treated with methotrexate and monitored in clinics under the auspices of Staffordshire Rheumatology Centre. Two clinical auditors collected data retrospectively from the computer database used to support monitoring of patients on disease-modifying anti-rheumatic drugs. Information was collected on duration of treatments and reasons for stopping treatment. For patients identified as having potentially serious side-effects or who died whilst taking methotrexate, further information on their outcome was collected from patients' medical notes and where applicable post mortem reports and death registers. RESULTS: Between 1986 and 1999, 673 patients were treated with methotrexate, of whom 551 had a diagnosis of rheumatoid arthritis. From the Kaplan-Meier analysis, the probability of patients remaining on treatment 5 yr after starting methotrexate was 0.74. Three hundred and sixteen patients stopped methotrexate between 1986 and 1999. In 117 patients, the methotrexate was restarted. Seventy-two patients (10.7% of all patients) stopped because of inefficacy or patient choice or situation. Thirty-seven patients (5.5%) stopped methotrexate due to abnormal haematology (usually low neutrophils). Thirty-seven patients (5.5%) stopped methotrexate due to abnormalities in liver function tests. Life-threatening side-effects were identified in 12 patients (1.8%). These included six pneumonitis, five cytopenias and one disseminated varicella zoster. Two of these patients (0.3%) died, one from pneumonitis and one from disseminated varicella zoster. A total of 25 patients (3.7%) died while taking methotrexate and four died (0.6%) within 3 months of stopping methotrexate. One death (0.15%) was directly attributable to methotrexate (methotrexate pneumonitis). CONCLUSION: This study has shown that methotrexate is well tolerated in clinical practice in the medium to long term. It has produced accurate data on the incidence of adverse effects of methotrexate in a local population in a non-research setting. It has identified the incidence of life-threatening side-effects to be 1.7% with one death (0.15%) directly due to methotrexate. This information should prove useful when recommending such treatment to patients with inflammatory arthritis.

Adolescent↗
PubMed2004

Spontaneous soliton formation and modulational instability in Bose-Einstein condensates.

The dynamics of an elongated attractive Bose-Einstein condensate in an axisymmetric harmonic trap is studied. It is shown that density fringes caused by self-interference of the condensate order parameter seed modulational instability. The latter has novel features in contradistinction to the usual homogeneous case known from nonlinear fiber optics. Several open questions in the interpretation of the recent creation of the first matter-wave bright soliton train [Nature (London) 417, 150 (2002)]] are addressed. It is shown that primary transverse collapse, followed by secondary collapse induced by soliton-soliton interactions, produces bursts of hot atoms at different time scales.

Journal Article↗
PubMed2004

Investigation of proton conductance in liver mitochondria of broilers with pulmonary hypertension syndrome.

We previously reported an impaired ability to regulate hepatic mitochondrial state 4 respiration rate in response to sequential additions of adenosine diphosphate in pulmonary hypertension syndrome (PHS). As proton conductance is a major contributor to State 4 respiration, the major goal of this study was to investigate the nature of proton conductance in hepatic mitochondria isolated from broilers with and without PHS. Broilers were placed on floor litter in environmental chambers and exposed to cold temperatures (15 degrees C) from 3 to 7 wk of age to induce PHS. Liver mitochondria were isolated from birds that exhibited PHS (cyanosis, right ventricular weight ratio > 0.30) or from birds that appeared healthy (no cyanosis, right ventricular weight ratio < 0.27). Isolated mitochondria were placed in a chamber equipped with the ability to measure oxygen content and mitochondrial membrane potential. The mitochondrial membrane potential was assessed by an ion sensitive electrode to measure the distribution of methyltriphenylphosphonium across the inner mitochondrial membrane. Proton conductance was assessed by simultaneously measuring State 4 oxygen consumption rate as respiration was progressively inhibited with increasing concentrations of malonate. The addition of cardiolipin, a lipid found in high concentrations in mitochondrial membranes that can alter proton conductance, had no affect on respiration or mitochondrial membrane potential in either group. The relationship of curves depicting State 4 respiration and mitochondrial membrane potential indicates that PHS mitochondria exhibit impaired substrate oxidation and reduced proton conductance relative to controls. These findings provide further characterization of the altered cellular oxygen utilization in broilers with PHS.

Animals↗
PubMed2003

Levinson-like theorem for scattering from a Bose-Einstein condensate.

A relation between the number of bound elementary excitations of an atomic Bose-Einstein condensate and the phase shift of elastically scattered atoms is derived. Within the Bogoliubov model of a weakly interacting Bose gas this relation is exact and generalizes Levinson's theorem. Specific features of the Bogoliubov model such as complex energy and continuum bound states are discussed and a numerical example is given.

Journal Article↗
PubMed2003

Regional genetic differentiation in Western Australian sandalwood (Santalum spicatum) as revealed by nuclear RFLP analysis.

Western Australian sandalwood, Santalum spicatum, is widespread in the semi-arid and arid regions of Western Australia, and there is some morphological variation suggestive of two ecotypes. The level and structuring of genetic diversity within the species was investigated using anonymous nuclear RFLP loci. Santalum spicatum showed moderate levels of genetic diversity compared to other Australian tree species. The northern populations in the arid region showed greater levels of diversity and less population differentiation than the southern populations in the semi-arid region due to differences in the distribution of rare alleles. Equilibrium between drift and gene flow in the northern populations indicated that they have been established for a long period of time with stable conditions conducive to gene flow. In contrast, the southern populations showed a relationship between drift and gene flow indicative of a pattern of fragmentation and isolation where drift has greater effect than gene flow. The different patterns of diversity suggest that the ecotypes in the two regions have been subject to differences in the relative influences of drift and gene flow during their evolutionary history.

Alleles↗
PubMed2003

Phylogeography and divergence in the chloroplast genome of Western Australian Sandalwood (Santalum spicatum).

Western Australian sandalwood (Santalum spicatum) is widespread throughout Western Australia across the semiarid and arid regions. The diversity and phylogeographic patterns within the chloroplast genome of S. spicatum were investigated using restriction fragment length polymorphism analysis of 23 populations. The chloroplast diversity was structured into two main clades that were geographically separated, one centred in the southern (semiarid region) and the other in the northern (arid) region. Fragmentation due to climatic instability was identified as the most likely influence on the differentiation of the lineages. The lineage in the arid region showed a greater level of differentiation than that in the southern region, suggesting a higher level of gene flow or a more recent range expansion of sandalwood in the southern region. The phylogeographic pattern in the chloroplast genome is congruent with that detected in the nuclear genome, which identified different genetic influences between the regions and also suggested a more recent expansion of sandalwood in the southern region.

Chloroplasts↗
PubMed2001

Pyruvated galactose and oligosaccharides from Erwinia chrysanthemi Ech6 extracellular polysaccharide.

The acidic extracellular polysaccharide of Ech6 was depolymerized by fuming HCl. The pyruvated sugars were isolated and characterized by methods that included a combination of low-pressure gel-filtration and high-pH anion-exchange chromatographies, methylation linkage analyses, mass (GC-MS and MALDI-TOF MS) and 1H NMR (1D and 2D) spectroscopies. The following pyruvated sugars were obtained: 4,6-O-(1-carboxyethylidene)-D-Galp; 4,6-O-(1-carboxyethylidene)- alpha-D-Galp-(1-->4)-beta-D-GlcAp-(1-->3)-D-Galp; 4,6-O-(1-carboxyethylidene)-alpha-D-Galp-(1-->4)-alpha-D-GlcAp- (1-->3)-alpha-D-Galp-(1-->3)-L-Fucp; 4,6-O-(1-carboxyethylidene)-alpha-D-Galp-(1-->4)-beta-D-GlcAp-(1-->3) -alpha-D-Galp-(1-->3)-L-[beta-D-Glcp-(1-->4)]-Fucp. These oligosaccharides present potential haptenes for the development of specific antibodies and confirm the partial structure proposed previously for the extracellular polysaccharide from Erwinia chrysanthemi Ech6 [Yang, B. Y.; Gray, J. S. S.; Montgomery, R. Int. J. Biol. Macromol., 1994, 16, 306-312].

Carbohydrate Conformation↗
PubMed2001

Bisphosphonate therapy in fibrous dysplasia.

Fibrous dysplasia is proliferation of fibrous tissue within the bone marrow causing osteolytic lesions and pathologic fractures. Recently, second generation bisphosphonates have shown promise in the treatment of patients with fibrous dysplasia. In the current study, six patients with fibrous dysplasia were treated with either oral alone or oral and intravenous bisphosphonates. The participants were observed for changes in N-telopeptide, pain score, and radiographic changes. In the current study, the combination bisphosphonate therapy diminished pain, prevented fractures, lowered N-telopeptide values, and led to partial resolution of fibrous dysplasia lesions.

Administration, Oral↗
PubMed2001

[Quality of outcome in treating patients with chronic headache within a hospital specialized for migraine. A cohort study with one-year follow-up].

AIMS: To describe characteristics of in-patients with chronic headache syndromes being treated with complementary methods, short-term effects at time of discharge as well as long-term effects covering a catamnesis of 1 year. METHODS: The study was designed as a prospective cohort study with outcome measurements 2 months in advance of admission to the hospital, at admission, and at time of discharge, continued by follow-up queries 2, 6 and 12 months after discharge from the hospital. The parameters for describing the course of headache symptoms were registered by questionnaires and diaries. During the first 6 months in 1996, a total of 424 consecutive patients with migraine or tension-type headache at the 'Migräne-Klinik Königstein' were included. RESULTS: 82.9% of the patients were women, the mean age was 46.3 +/-13.0 years. The median of the duration of the disease was 23 years. At discharge from the hospital there was a marked improvement regarding frequency of headache attacks, intensity of headaches, and concomitant symptoms. 60.5% of the patients were classified as 'responders'. 67.5% responded to follow-up questionnaires. With exception of the duration of headache attacks, a significant improvement regarding the 6-month follow- up compared to base level was observed. Intake of drugs could be diminished and quality of life was improved. Patients suffering from tension-type headache showed smaller effects in general. CONCLUSIONS: Taking into account the mean duration of disease of more than 20 years the results suggest a clinically relevant success from the patients' view regarding the short-term as well as the long-term course. The problem of data loss with follow-up queries and missing comparative data reduce the conclusiveness of the results.

Adult↗
PubMed2000

Biomechanical comparison of quadriceps tendon fixation with patellar tendon bone plug interference fixation in cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to use current fixation techniques and compare the stiffness and ultimate tensile failure of the tendinous end of the quadriceps tendon (QT) with the bone plug end of the bone-patellar tendon-bone (BPTB) graft using current techniques of fixation. TYPE OF STUDY: Randomized trial of elderly cadaver knees. MATERIALS AND METHODS: Tibial and femoral biodegradable interference fixation and femoral EndoButton (Smith & Nephew, Acufex, Mansfield, MA) fixation in bone tunnels with the QT and the BPTB graft were compared by using 10 pairs of elderly cadavers and biomechanical testing. Two groups, fixation at time zero (simulating fixation in the operating room) and testing after 1, 000 loading cycles (simulating patient rehabilitation exercises), were used. RESULTS: At time zero fixation, stiffness of the soft tissue QT tibial tunnel interference fixation was 59% less stiff than the stiffness of the interference fixation of a BPTB plug in a femoral tunnel (P =.11). The EndoButton femoral fixation resulted in a decrease in stiffness at time zero compared with femoral tunnel interference fixation of the soft tissue QT (P =.03). All groups improved stiffness with cycling the construct to 1,000 cycles. CONCLUSIONS: Placement of the QT tendinous end of the graft in the femoral bone tunnel when using a interference fixation will approximate the stiffness of a bone plug in the tibial bone tunnel with interference fixation. The EndoButton fixation is not as stiff as either of the femoral interference fixation options. The addition of more than 20 loading cycles could remove laxity from the graft fixation-graft cruciate ligament complex and improve its stiffness.

Anterior Cruciate Ligament↗
PubMed2000

Progressive infantile neurodegeneration caused by 2-methyl-3-hydroxybutyryl-CoA dehydrogenase deficiency: a novel inborn error of branched-chain fatty acid and isoleucine metabolism.

We report a novel inborn error of metabolism identified in a child with an unusual neurodegenerative disease. The male patient was born at term and recovered well from a postnatal episode of metabolic decompensation and lactic acidosis. Psychomotor development in the first year of life was only moderately delayed. After 14 mo of age, there was progressive loss of mental and motor skills; at 2 years of age, he was severely retarded with marked restlessness, choreoathetoid movements, absence of directed hand movements, marked hypotonia and little reaction to external stimuli. Notable laboratory findings included marked elevations of urinary 2-methyl-3-hydroxybutyrate and tiglylglycine without elevation of 2-methylacetoacetate, mild elevations of lactate in CSF and blood, and a slightly abnormal acylcarnitine profile. These abnormalities became more apparent after isoleucine challenge. Enzyme studies showed absent activity of 2-methyl-3-hydroxybutyryl-CoA dehydrogenase (MHBD) in the mitochondrial oxidation of 2-methyl branched-chain fatty acids and isoleucine. Under dietary isoleucine restriction, neurologic symptoms stabilized over the next 7 months.

3-Hydroxyacyl CoA Dehydrogenases↗
PubMed1999

Family interactions as targets for intervention to improve social adjustment after epilepsy surgery.

PURPOSE: To identify family interactions associated with psychosocial outcome of epilepsy surgery, to design interventions to improve patient outcome. METHODS: A cross-sectional, case series study of relations among observed family behavior and psychosocial outcome of 43 patients after temporal lobectomy. Videotaped family behavior during family discussion tasks was rated for predominant family affect, affective range, and support of patient autonomy. Multiple regression analyses tested the relation of observed family characteristics to outcomes, controlling for seizure control and other psychological and disease characteristics. RESULTS: Predominant family affect predicted patients' social adjustment independent of postoperative seizure status and other disease characteristics. The relation between predominant affect and social adjustment was stronger among patients with persisting complex partial seizures (CPSs; r = -0.91), versus patients with auras (r = -0.38) and seizure-free patients (r = -0.28; multiple R = 0.71; p < 0.05). Families with a positive affective climate supported patients' autonomy. CONCLUSIONS: Two potential targets were identified for family intervention to improve postsurgical social adjustment: (a) family interactions that support a predominantly positive affective climate, and (b) family interactions that support patient autonomy. These findings are consistent with findings in normal and other clinical populations. They identify specific interactions that give rise to positive versus negative affective climate and support versus undermining of autonomy. These results lay the groundwork for intervention studies targeting these specific family interactions. Such intervention studies would clarify the direction of effect of the observed relationships and would test the efficacy of family intervention for improving psychosocial outcomes for patients with epilepsy.

Adult↗
PubMed1999

A three-day course of dexamethasone therapy to prevent chronic lung disease in ventilated neonates: a randomized trial.

BACKGROUND: Although several trials of early dexamethasone therapy have been completed to determine if such therapy would reduce mortality and chronic lung disease (CLD) in infants with respiratory distress, optimal duration and side effects of such therapy remain unknown. PURPOSE: The purpose of this study was: 1) to determine if a 3-day course of early dexamethasone therapy would reduce CLD and increase survival without CLD in neonates who received surfactant therapy for respiratory distress syndrome and 2) to determine adverse effects associated with such therapy. DESIGN: This was a prospective multicenter randomized trial comparing a 3-day course of dexamethasone therapy beginning at 24 to 48 hours of life to placebo therapy. Two hundred forty-one neonates (dexamethasone n = 118, placebo n = 123), who weighed between 500 g and 1500 g, received surfactant therapy, and were at significant risk for CLD or death using a model to predict CLD or death at 24 hours of life, were enrolled in the trial. Infants randomized to receive early dexamethasone were given 6 doses of dexamethasone at 12-hour intervals beginning at 24 to 48 hours of life. The primary outcomes compared were survival without CLD and CLD. CLD was defined by the need for supplemental oxygen at the gestational age of 36 weeks. Complication rates and adverse effects of study drug therapy were also compared. RESULTS: Neonates randomized to early dexamethasone treatment were more likely to survive without CLD (RR: 1.3; 95% CI: 1.03, 1.7) and were less likely to develop CLD (RR: 0.6; CI: 0.3, 0. 98). Mortality rates were not significantly different. Subsequent dexamethasone therapy use was less in early dexamethasone-treated neonates (RR: 0.8; CI: 0.7, 0.96). Very early (</=7 days of life) intestinal perforations were more common among dexamethasone-treated neonates (8% vs 1%). CONCLUSION: We conclude that an early 3-day course of dexamethasone therapy increases survival without CLD, reduces CLD, and reduces late dexamethasone therapy in high-risk, low birth weight infants who receive surfactant therapy for respiratory distress syndrome. Potential benefits of early dexamethasone therapy at the dosing schedule used in this trial need to be weighed against the risk for early intestinal perforation.

Analysis of Variance↗
PubMed1998

Multiply-resistant Klebsiella pneumoniae: failure of spread in community-based elderly care facilities.

Thirty-eight patients colonized with multiply-resistant, plasmid-mediated, expanded-spectrum beta-lactamase (SHV-2) producing Klebsiella pneumoniae (MRK), were discharged from hospital to 22 nursing or residential homes during a hospital-based outbreak, in the Grampian region of north-east Scotland. MRK colonized the urinary tract in 74%, stool in 58%, respiratory tract in 29% and wounds in 11%. Mean length of colonization was 160 days (range 7-548). Mean length of stay in the homes after aquisition of MRK was 298 days. Compared with a control group of MRK-negative residents, MRK-positive residents had histories of more hospital admissions, underlying disease and complete immobility. Evaluation of these homes showed high standards of care and good facilities. Despite prolonged carriage of MRK by the index cases there was no evidence of spread to the other 886 residents who were screened, and there was evidence of only minor environmental contamination. Given the available evidence, patients colonized with MRK can be accommodated in good-quality nursing and residential homes, on discharge from hospital, with little fear of spread to other residents.

Aged↗
PubMed1998

Successful treatment with insulin analog lispro in IDDM with delayed absorption of subcutaneously applied human regular insulin and complicated intraperitoneal insulin infusion. A case report.

OBJECTIVE: To subcutaneously administer the insulin analog lispro in a patient with delayed absorption of subcutaneously applied human regular insulin whose continuous intraperitoneal insulin infusion (CIPII) with a percutaneous access device had required multiple surgical interventions because of complications. RESEARCH DESIGN AND METHODS: In a 35-year-old woman with long-term IDDM and delayed absorption of subcutaneously applied human regular insulin, a 3-year CIPII with human regular insulin via a percutaneous access device was complicated by three catheter obstructions and one subcutaneous abscess. Each complication required the implantation of a new percutaneous access device. During a 2-day trial with continuous subcutaneous insulin infusion (CSII) of the insulin analog lispro at basal infusion rates of 0.5-1.1 U/h, stable metabolic control was achieved. A 5-h intermediate attempt with human regular insulin in CSII, however, increased blood glucose concentrations from 6.0 to 28.8 mmol/l, despite identical basal rates and additional injection of 16 U of human regular insulin. Restarting with CSII of the insulin analog lispro reinforced stable metabolic control. CONCLUSIONS: It is suggested that the insulin analog lispro is a promising approach in the treatment of IDDM with delayed absorption of subcutaneously applied human regular insulin and a suitable alternative therapy for patients with complications attributed to percutaneous access devices for CIPII.

Administration, Cutaneous↗
PubMed1998

A clinical decision analysis of cryotherapy compared with expectant management for cervical dysplasia.

BACKGROUND: Screening for precursors of cervical cancer with colposcopic examination for women with abnormal Papanicolaou (Pap) smears identifies those with cervical dysplasia. Though the majority of mild dysplasias (CIN I) will regress, many are treated with cryotherapy. METHODS: We used decision analysis to compare immediate cryotherapy with expectant management (following with another Pap smear or colposcopy, with treatment reserved for progression or a duration of 2 years). The decision tree included the possibility of more invasive surgical procedures if the cryotherapy was ineffective or if the dysplasia progressed in extent of cervical involvement or in grade. Probabilities were derived from literature review and expert judgment. The analysis considered the disutility of the follow-up examinations, cryotherapy, and the more invasive procedures, using expert assessment. RESULTS: Using the baseline assumptions, expectant management led to a better outcome for most patients (57%), who recover with no procedure. However, more patients treated with expectant management required surgical procedures (loop electrosurgical excisional procedure, conization, or, rarely, hysterectomy) than did those treated with immediate cryotherapy. In the expected disutility analysis, expectant management was better than immediate cryotherapy. Sensitivity analysis showed that three factors had the potential to change the recommendation of the analysis: (1) the probability the dysplasia will regress, (2) the disutility of the process of expectant management, and (3) the disutility of invasive procedures compared with cryotherapy. CONCLUSIONS: The analysis indicated that expectant management is preferable to immediate cryotherapy for women with histologically proven mild cervical dysplasia. However, this conclusion depended on assumptions about three factors for which there is insufficient evidence in the literature. More research is needed.

Colposcopy↗
PubMed1997

Molecular analysis of katG gene mutations in strains of Mycobacterium tuberculosis complex from Africa.

A sample of 124 isoniazid (INH)-resistant and 88 susceptible strains of Mycobacterium tuberculosis complex from south, central, and west Africa was analyzed by direct sequence analysis and PCR-restriction fragment length polymorphism analysis of their catalase-peroxidase (katG) genes. Point mutations at codon 315 were found in the genomes of 64% of INH-resistant strains, but no complete deletions were identified. Mutations at codon 463 were independent of INH resistance and were linked to the geographic origins of the strains.

Africa↗