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Biomedical subjects

J D Ward

Publications and source records attributed to J D Ward.

At least 19 recordsLinked to original sources
PubMed2003

Increased sural nerve epineurial blood flow in human subjects with painful diabetic neuropathy.

AIMS/HYPOTHESIS: The pathogenesis of painful diabetic neuropathy remains unknown. As a consequence we still do not have any effective, rational treatments and a greater understanding of the mechanisms is urgently required. Previous studies have shown no consistent morphological differences in the nerves of patients with and without painful neuropathy. The aim of this study was to compare epineurial haemodynamics in patients with chronic painful and painless neuropathy. METHODS: The techniques of microlightguide spectrophotometry and fluorescein angiography were used to measure epineurial intravascular oxygen saturation and blood flow respectively. Eleven patients with painful and eight with painless neuropathy were studied, with the groups matched carefully in terms of severity of neuropathy and diabetes control. RESULTS: Intravascular oxygen saturation was higher in the painful neuropathy group compared to those without pain (median 73.8% vs 67.7%, respectively; p=0.021). Fluorescein rise time was also faster in those with painful symptoms (median 18.3 s vs 53.6 s; p=0.046) indicating higher epineurial blood flow in these subjects. CONCLUSION/INTERPRETATION: These results indicate that there are distinct differences in haemodynamics within the epineurium of the sural nerve in subjects with painful and painless neuropathy. Haemodynamic factors could therefore have an important role in the pathogenesis of neuropathic pain and might offer further insight into potential treatments for this distressing condition.

Blood Flow Velocity↗
PubMed2003

Zonal function network frames on the sphere.

We introduce a class of zonal function network frames suitable for analyzing data collected at scattered sites on the surface of the unit sphere of a Euclidean space. Our frames consist of zonal function networks and are well localized. The frames belonging to higher and higher scale wavelet spaces have more and more vanishing polynomial moments. The main technique is applicable in the general setting of separable Hilbert spaces, in which context, we study the construction of new frames by perturbing an orthonormal basis.

Neural Networks, Computer↗
PubMed2003

Effects of organic forms of zinc on growth performance, tissue zinc distribution, and immune response of weanling pigs.

This study was conducted to determine the effect of zinc level and source on growth performance, tissue Zn concentrations, intracellular distribution of Zn, and immune response in weanling pigs. Ninety-six 3-wk-old crossbred weanling pigs (BW = 6.45 +/- 0.17 kg) were assigned to one of six dietary treatments (four pigs per pen, four replicates per treatment) based on weight and litter origin. Treatments consisted of the following: 1) a corn-soybean meal-whey diet (1.2% lysine) with a basal level of 80 ppm of supplemental Zn from ZnSO4 (control; contained 104 ppm total Zn); 2) control + 80 ppm added Zn from ZnSO4; 3) control + 80 ppm added Zn from Zn methionine (ZnMet); 4) control + 80 ppm added Zn from Zn lysine (ZnLys); 5) control + 40 ppm added Zn from ZnMet and 40 ppm added Zn from ZnLys (ZnML); and 6) control + 160 ppm added Zn from ZnSO4. Zinc supplementation of the control diet had no effect on ADG or ADFI. Gain efficiency was less (P < 0.05) for pigs fed 80 ppm of Zn from ZnSO4 than for control pigs and pigs fed 160 ppm of Zn from ZnSO4. Organ weights, Zn concentration, and intracellular distribution of Zn in the liver, pancreas, and spleen were not affected (P = 0.12) by Zn level or source. Skin thickness response to phytohemagglutinin (PHA) was not affected (P = 0.53) by dietary treatment. Lymphocyte proliferation in response to PHA was greater (P < 0.05) in pigs fed ZnLys than in pigs fed the control diet or the ZnML diet; however, when pokeweed mitogen was used, lymphocyte proliferation was greatest (P < 0.05) in pigs fed the ZnMet diet than pigs fed the control, ZnLys, ZnML, or 160 ppm ZnSO4 diets. Antibody response to sheep red blood cells was not affected by dietary treatments. Supplementation of 80 ppm of Zn from ZnSO4 or ZnMet and 160 ppm of Zn from ZnSO4 decreased (P < 0.05) the antibody response to ovalbumin on d 7 compared with control pigs, but not on d 14. Phagocytic capability of peritoneal exudate cells was increased (P < 0.05) when 160 ppm of Zn from ZnSO4 was supplemented to the diet. The number of red blood cells ingested per phagocytic cell was increased (P < 0.05) in pigs fed the diet supplemented with a combination of ZnMet and ZnLys and the diet with 160 ppm of Zn from ZnSO4. Results suggest that the level of Zn recommended by NRC for weanling pigs was sufficient for optimal growth performance and immune responses, although macrophage function may be enhanced at greater levels of Zn. Source of Zn did not alter these measurements.

Animal Nutritional Physiological Phenomena↗
PubMed2002

Insulin improves well-being for selected elderly type 2 diabetic subjects.

The effects of insulin therapy on patient well-being, treatment satisfaction and mood, and on carer strain were studied in 30 elderly Type 2 diabetic patients (age 73 +/- 7 (SD) yr) in poor glycaemic control on tablet therapy. A comparison group of ten poorly controlled patients who remained on oral agents was also studied. After 4 weeks of insulin treatment, there were significant improvements in mental health, role-emotional, role-physical (all P<0.05) and vitality (P<0.01) domains of the short form health survey (SF-36), and also in the diabetes treatment and satisfaction questionnaire (DTSQ) and geriatric depression scale (both P<0.01) compared to baseline. After 12 weeks, the improvements in mental health, social functioning and vitality (P<0.01 for all domains), and in the DTSQ were sustained. Carer strain was lower at 4 weeks. No changes in outcomes were seen in the comparison group. In selected elderly Type 2 diabetic patients, insulin treatment is associated with significant improvements in well-being, treatment satisfaction and mood, even without significant improvements in glycaemic control and without increase in carer strain. The SF-36 and DTSQ are sensitive to the benefits of the changes in the treatment for these patients.

Administration, Oral↗
PubMed2002

Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study.

AIMS: To assess the prevalence of and risk factors for autonomic neuropathy in the EURODIAB IDDM Complications Study. METHODS: The study involved the examination of randomly selected Type I (insulin-dependent) diabetic patients from 31 centres in 16 European countries. Neuropathic symptoms and two tests of autonomic function (changes in heart rate and blood pressure from lying to standing) were assessed and data from 3007 patients were available for the present analysis. Autonomic neuropathy was defined as an abnormality of at least one of the tests. RESULTS: The prevalence of autonomic neuropathy was 36% with no sex differences. The frequency of one and two abnormal reflex tests was 30% and 6%, respectively. The R-R ratio was abnormal in 24% of patients while 18% had orthostatic hypotension defined as a fall in systolic blood pressure > 20 mmHg on standing. Significant correlations were observed between autonomic neuropathy and age (P < 0.01), duration of diabetes (P < 0.0001), HbA1c (P < 0.0001), diastolic blood pressure (P < 0.05), lower HDL-cholesterol (P < 0.01), the presence of retinopathy (P < 0.0001) and albuminuria (P < 0.0001). New associations have been identified from the study: the strong relationship of autonomic neuropathy to cigarette smoking (P < 0.01), total cholesterol/HDL-cholesterol ratio (P < 0.05) and fasting triglyceride (P < 0.0001). As a key finding, autonomic neuropathy was related to the presence of cardiovascular disease (P < 0.0001). All analyses were adjusted for age, duration of diabetes and HbA1c. However, data have been only partly confirmed by logistic regression analyses. Frequency of dizziness on standing up was 18%, while only 4% of patients had nocturnal diarrhoea and 5% had problems with bladder control. CONCLUSION: Cardiovascular reflex tests, even in the form of the two tests applied, rather than a questionnaire, seem to be appropriate for the diagnosis of autonomic neuropathy. The study has identified previously known and new potential risk factors for the development of autonomic neuropathy, which may be important for the development of risk reduction strategies. Our results may support the role of vascular factors in the pathogenesis of autonomic neuropathy.

Adolescent↗
PubMed2001

Spinal-cord involvement in diabetic peripheral neuropathy.

The pathogenesis of diabetic distal symmetrical polyneuropathy (DSP) is poorly understood but there is some evidence that the disease process might extend beyond peripheral nerves. We used magnetic-resonance imaging to measure spinal-cord cross-sectional area in diabetic patients with and without DSP and in healthy controls. There were significant differences in cord area between the groups at C4/5 and T3/4 (p=0.004 and p=0.033, respectively), with a smaller cord area in those with DSP compared with controls (p=0.001 and p=0.016 for C4/5 and T3/4, respectively). These results indicate that DSP is not simply a disease of the peripheral nerve and that there is substantial involvement of the spinal cord.

Adult↗
PubMed2001

Blood pressure response to standing in the diagnosis of autonomic neuropathy: the EURODIAB IDDM Complications Study.

Autonomic neuropathy is associated with poor prognosis. Cardiovascular reflexes are essential for the diagnosis of autonomic nerve dysfunction. Blood pressure response to standing is the most simple test for the evaluation of sympathetic integrity, however it is still discussed which diagnostic criteria of abnormal response should be considered as optimal. The EURODIAB IDDM Complications Study involved the examination of randomly selected Type 1 diabetic patients from 31 centres in 16 European counties. Data from 3007 patients were available for the present evaluation. Two tests of autonomic function (response of heart rate /R-R ratio/ and blood pressure from lying to standing) just as the frequency of feeling faint on standing up were assessed. R-R ratio was abnormal in 24% of patients. According to different diagnostic criteria of abnormal BP response to standing (>30 mmHg, >20 mmHg, and >10 mmHg fall in systolic BP), the frequency of abnormal results was 5.9%, 18% and 32%, respectively (p < 0.001). The frequency of feeling faint on standing was 18%, thus, it was identical with the prevalence of abnormal blood pressure response to standing when >20 mmHg fall in systolic blood pressure was considered as abnormal. Feeling faint on standing correlated significantly with both autonomic test results (p < 0.001). A fall >20 mmHg in systolic blood pressure after standing up seems to be the most reliable criterion for the assessment of orthostatic hypotension in the diagnosis of autonomic neuropathy in patients with Type 1 diabetes mellitus.

Adolescent↗
PubMed2001

Results of cranial vault reshaping.

This study was designed to assess the outcome of cranial vault reshaping for correction of deformity of the skull and the upper face. A retrospective review of all children who underwent cranial vault reshaping by a single team of surgeons between 1993 and 1996 was performed. There were 10 children in the series. The age at surgery ranged from 6 to 62 months (mean age, 25 months). Five children in the series had untreated sagittal craniosynostosis with scaphocephaly, two had pansynostosis resulting in cloverleaf skull deformity, and three had turricephaly after shunt treatment of hydrocephalus. There was no operative mortality. Blood loss ranged from 250 to 1,500 ml (mean, 422 ml). All patients needed transfusion. There were two major complications resulting from increased intracranial pressure, but both patients recovered completely with no neurological sequelae. Titanium plates and screws were used in all patients, but were removed in two when they became palpable. The 5 children with sagittal craniosynostosis had a normal head shape. The 2 children with cloverleaf skull have improved head shape with persistent increased bitemporal width and round faces. The 3 children with turricephaly after shunting have marked improvement with mild persistent deformity. This study shows that cranial vault reshaping is safe and can lead to a long-term normal head shape in children with late correction of sagittal craniosynostosis. Children with more severe anomalies, particularly syndromic patients, can be improved but will have persistent mild deformity.

Cerebrospinal Fluid Shunts↗
PubMed2001

Chemical composition, ensiling characteristics, and apparent digestibility of summer annual forages in a subtropical double-cropping system with annual ryegrass.

A 2-yr study was conducted to determine the chemical composition and digestibility of silages made from forage sorghum, pearl millet, and tropical corn managed to optimize forage quality. Silages were ensiled in upright concrete silos lined with plastic and fed to heifers to determine in vivo apparent digestibility. Samples were collected before and after ensiling to determine ensiling characteristics and forage quality. After ensiling, tropical corn had the greatest dry matter (DM), the lowest crude protein, and the greatest water-soluble concentrations. Tropical corn silage had a pH of 3.96. The pH of forage sorghum silage was 4.09, and pearl millet had a pH of 4.50. Pearl millet had the lowest concentration of preensiled water-soluble carbohydrate, which likely caused the high pH in the silage. There were no differences among the forages in DM loss during ensiling in yr 2. Heifers fed pearl millet silage consumed more DM, but digestible DM intake was not different among the three groups of heifers. The results of this experiment indicate that pearl millet would be less desirable as a crop intended solely for silage production. Both forage sorghum and tropical corn could be grown specifically for ensiling based on DM digestibility. The decision on which crop to use should be based on factors such as production costs, forage yields, and local growing conditions rather than silage quality.

Animal Feed↗
PubMed2001

Supplemental dietary protein for grazing dairy cows: effect on pasture intake and lactation performance.

One hundred twenty-four cows (92 multiparous and 32 primiparous) were used to evaluate the effect of grain supplements containing high crude protein [(22.8% CP, 5.3% rumen undegradable protein (RUP), dry matter basis], moderate CP (16.6% CP, 6.1% RUP), and moderate CP with supplemental RUP (16.2% CP, 10.8% RUP) on lactation performance of Holstein cows rotationally grazing annual ryegrass-oat pastures. Supplemental protein was provided by solvent extracted soybean meal in the high CP and moderate CP supplements and as a corn gluten meal-blood meal mixture (2.8:1) in the moderate CP, high RUP supplement. Cows were blocked according to previous mature milk equivalent production and calving date (partum group; 0 d in milk or postpartum group; 21 to 65 d in milk) and randomly assigned to dietary treatments. Grain was individually fed, at approximately a 1:3 grain to milk ratio, before a.m. and p.m milkings. The study was replicated during two grazing seasons that averaged 199 d. Cows had ad libitum access to bermudagrass hay while on pasture (dry matter intake = 1.3 kg/d). Protein supplementation had no effect on study long pasture dry matter (12.7 +/- 1.0 kg/d) or total dry matter (23.9 +/- 1.2 kg/d) consumption. Protein concentration did not affect actual milk yield of either calving group (high CP vs. moderate CP); however, postpartum group cows receiving high CP grain supplements maintained greater milk fat concentrations (3.34 vs. 3.11%), which led to higher fat-corrected milk (FCM) yields than control cows receiving moderate CP grain diets (30.3 vs. 28.9 kg/d). Crude protein concentration in milk of high CP-supplemented, postpartum group cows was also higher than moderate CP cows (3.42 vs. 3.27%). Additional RUP did not increase FCM yield above that generated by moderate CP grain diets for partum (34.3 vs. 32.9 kg/d) or postpartum-group cows (28.9 vs. 28.2 kg/d). Increasing CP concentration of grain supplement did not affect milk yield of Holstein cows grazing immature winter annual pastures. Supplementing additional RUP was without benefit, indicating that in this study energy deprivation may have been the major nutritional constraint for high-producing dairy cows grazing lush pastures.

Animal Feed↗
PubMed2001

Supplemental dietary protein for grazing dairy cows: reproduction, condition loss, plasma metabolites, and insulin.

An experiment was conducted over a 2-yr period to investigate the influence of grain crude protein (CP) and rumen undegradable protein (RUP) concentration on reproduction and energy status of dairy cows grazing annual ryegrass (Lolium multiflorum) and oats (Avena sativa). Holstein cows (n = 122) were blocked by calving group [partum (0 d postpartum) vs. postpartum (41 +/- 19 d postpartum at study initiation)] and assigned to grain supplements containing high CP [22.8% of dry matter (DM)], moderate CP (16.6%), or moderate CP (16.2%)] supplemented with RUP from blood meal and corn gluten meal. Postpartum condition loss was greater and first-service pregnancy rate was lower for partum-group cows receiving high CP grain supplements compared with control cows receiving moderate CP supplements. The RUP supplements reduced grain consumption, increased days to first estrus, and reduced first-service pregnancy rate of partum-group cows. The reproduction of postpartum group cows was unaffected by protein supplements. Plasma urea nitrogen was higher for cows fed high CP diets, but plasma ammonia nitrogen, glycated hemoglobin, nonesterified fatty acids, beta-hydoxybutyrate, glucose, and insulin concentrations were similar to cows fed moderate CP. Excess postpartum condition loss, coupled with inconsistent protein supplement effects on days to first service and first-service pregnancy rate, suggest that energy deprivation may have contributed to the low fertility experienced by grazing cows in this study.

Ammonia↗
PubMed2001

Effect of protein source and soluble carbohydrate addition on rumen fermentation and lactation performance of Holstein cows.

Rumen in vitro and in vivo experiments were conducted to evaluate the effect of rumen undegradable protein and soluble carbohydrates on rumen ammonia N release and lactation performance of Holstein cows. In the in vitro experiment, freeze-dried annual ryegrass (Lolium multiflorum, LAM) pasture was supplemented 1:1 with ground corn-based grain supplements containing expeller or solvent soybean meal with sucrose or lactose supplements at 0, 2.5, or 5% of dry matter (DM). The ammonia release rate was slower with expeller compared with solvent soybean meal-supplemented diets. Sucrose supplementation at the 5% level lowered rumen ammonia concentrations, but lactose-fortification of grain supplements was without effect. In the in vivo study, 32 multiparous Holstein cows were blocked according to milk yield and randomly assigned to corn-based grain supplements containing 1) solvent soybean meal, 2) solvent soybean meal + 5% sucrose supplement, 3) expeller soybean meal, or 4) expeller soybean meal + 5% sucrose supplement. Grain supplements and fresh annual ryegrass were component fed at approximately a 1:1 grain to forage ratio (DM basis). Forage DM intake was higher for cows receiving solvent soybean meal supplemented grain supplements than those receiving expeller soybean meal (12.2 +/- 2.1 vs. 11.4 +/- 2.2 kg/d), but total DM intake was similar for all diets (22.8 +/- 2.9 kg/d). Fat-corrected milk yield was similar for all diets averaging 37.5, 38.2, 39.1, and 37.6 kg/d for diets 1 to 4, respectively. Rumen fermentation, milk urea nitrogen, and body condition were unaffected by supplements; however, cows fed grain supplement 1 utilized dietary energy more efficiently than cows offered the other dietary treatments. High dietary crude protein concentrations may have limited lactation response to rumen undegradable protein and sugar.

Ammonia↗
PubMed2001

An exercise in communication:-analysis of calls to a meningococcal disease hotline.

We describe our experience with a hotline which was set up to deal with enquiries relating to a secondary school mass vaccination campaign against meningococcal disease. Three thousand, three hundred calls were received over 6 days, mostly from the general public but also from contacts of the school and health practitioners. The hotline served as an important means of providing consistent advice and reassurance to the public and reduced the burden of calls to hospitals and public health units.

Australia↗
PubMed2000

'Sausage toe': a reliable sign of underlying osteomyelitis.

AIMS: To follow-up patients with a 'sausage' deformity of the toe associated with local neuropathic ulceration to confirm the diagnosis of underlying osteomyelitis. This was based on our observation that some diabetic patients with suspected pedal osteomyelitis with a local neuropathic ulcer have a 'sausage' deformity of a toe. METHODS: Over a period of 2 years, 14 patients with foot ulcers, who were observed to have the 'sausage' deformity of a toe in the diabetic foot clinic were followed up and investigated. RESULTS: Underlying osteomyelitis was confirmed in six on the very first X-ray examination. A further seven had osteomyelitis diagnosed on bone scanning. Both the X-ray and the bone scan were equivocal in one patient, whose ulcer only healed after an 8-week course of antibiotics. Antibiotic therapy was successful in 11 patients and three patients required amputation of the affected toe. Following successful treatment, there was full resolution of the 'sausage toe' in the majority. CONCLUSIONS: The appearance of a 'sausage toe' should alert the physician of the possibility of underlying osteomyelitis in diabetic foot, so that prompt treatment can be commenced with antibiotics.

Adult↗
PubMed2000

Pediatric cancer survivors: assessment of late effects.

As pediatric cancer treatment technology continues to progress, so does the increasing pool of pediatric cancer survivors. In the past, survival studies were based on the fifth year following the diagnosis. Currently, follow-up care is imperative beyond the first 5 years. Although cure is achieved for many children, late effects from treatment occur in many survivors. As this population continues to increase, so does the need for health care providers to monitor and treat these individuals. Pediatric cancer survivors require specific screening to determine the late effects of treatment. Many treatment consequences can be alleviated through proper assessment and treatment.

Adaptation, Psychological↗
PubMed2000

Central nervous system leiomyosarcoma in patients with acquired immunodeficiency syndrome. Report of two cases.

Leiomyosarcomas (LMSs) of the central nervous system are extremely rare; however, they are becoming more prevalent in immunocompromised patients. The authors present the cases of two patients with acquired immunodeficiency syndrome: one with LMS of the thoracic vertebral body and the other with LMS originating from the region of the cavernous sinus. The epidemiological and histological characteristics of LMS and its association with latent Epstein-Barr virus are discussed, as well as the treatments for this neoplasm.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Contribution of edema and cerebral blood volume to traumatic brain swelling in head-injured patients.

OBJECT: The pathogenesis of traumatic brain swelling remains unclear. The generally held view is that brain swelling is caused primarily by vascular engorgement and that edema plays a relatively minor role in the swelling process. The goal of this study was to examine the roles of cerebral blood volume (CBV) and edema in traumatic brain swelling. METHODS: Both brain-tissue water and CBV were measured in 76 head-injured patients, and the relative contribution of edema and blood to total brain swelling was determined. Comparable measures of brain-tissue water were obtained in 30 healthy volunteers and CBV in seven volunteers. Brain edema was measured using magnetic resonance imaging, implementing a new technique for accurate measurement of total tissue water. Measurements of CBV in a subgroup of 31 head-injured patients were based on consecutive measures of cerebral blood flow (CBF) obtained using stable xenon and calculation of mean transit time by dynamic computerized tomography scanning after a rapid bolus injection of iodinated contrast material. The mean (+/- standard deviation) percentage of swelling due to water was 9.37+/-8.7%, whereas that due to blood was -0.8+/-1.32%. CONCLUSIONS: The results of this study showed that brain edema is the major fluid component contributing to traumatic brain swelling. Moreover, CBV is reduced in proportion to CBF reduction following severe brain injury.

Adolescent↗