Biomedical subjects

J Falconer

Publications and source records attributed to J Falconer.

At least 37 records · Page 2Linked to original sources

PubMed1992

Seeing the forest despite the trees. The benefit of exploratory data analysis to program evaluation research.

In the present article, it is argued that there is a benefit to applying techniques of exploratory data analysis (EDA) to program evaluation. To exemplify this, an evaluation of a rehabilitation program for people with rheumatoid arthritis is presented. The perceived health status of patients receiving intensive rehabilitation services from a major rehabilitation institute was compared with that of patients receiving customary office-based care over an 18-month period. The data were analyzed in a conventional way (analysis of variance) and then by way of EDA techniques (graphic display of medians and boxplots). The conventional analysis suggested that all patients improved over time and that intensive rehabilitation services provided no particular benefit or harm. The exploratory analysis showed that the distribution of the outcome variable was patently nonnormal, thus casting doubt on the validity of the conventional analysis. The EDA further showed that the rehabilitation group lagged behind the comparison group for a year, with a precipitious improvement at the 18-month period. This suggests that a selection factor was operating (i.e., those in the rehabilitation group could have been sicker) or that the patients in the rehabilitation group were made more aware of their condition by the intensive health services they received. The EDA provided an important insight.

Analysis of Variance↗

PubMed1991

A simple method to measure gait for use in arthritis clinical research.

This report describes and discusses a simple, inexpensive method to quantify step length, stride width, cadence (steps per minute), and velocity (centimeters per second) for use as outcome measures in arthritis clinical trials. The method involves footprint recordings taken during gait on pressure-sensitive paper. Data from 42 adults with osteoarthritis of the knee and a brief review of the literature suggest that gait measurements using this method are reliable, valid, and practical.

Aged↗

PubMed1991

Hand splinting in rheumatoid arthritis. A perspective on current knowledge and directions for research.

A theoretical rationale for the use of hand splints in rheumatoid arthritis and selected literature relevant to the efficacy of splints in the acutely inflamed or chronic rheumatoid joint are briefly reviewed. The purposes of this review are to provide a broad perspective on nonsurgical hand splinting and to suggest some directions for future research based on this perspective.

Acute Disease↗

PubMed1991

Release of insulin-like growth factor I by the sheep placenta in vitro.

This study has utilized a tissue perifusion system to examine the release of insulin-like growth factor I (IGF I) from different regions of the sheep placenta at two stages of gestation. Placentae were obtained from ewes at either 116 +/- 7 (mean +/- s.e.) or 144 +/- 1.5 days of gestation and separated into the maternal basal plate or chorionic villous tissue. At both ages, the maternal basal plate tissue released approximately three times more IGF I than the chorionic villous tissue. No difference was found between the rate of release of IGF I from the maternal basal plate at 120 and 140 days of gestation, whereas the chorionic villous tissue released less IGF I later in gestation. Maternal basal plate tissue was less responsive to a depolarizing dose of KCl than was chorionic villous tissue at either age. After acid gel chromatography, perfusate from the basal plate had three peaks of IGF immunoreactivity (corresponding to binding protein, IGF I and a form with an intermediate molecular weight). In contrast, the chorionic villous tissue released only a form with a high molecular weight, corresponding to binding protein. These results demonstrate that the sheep placenta produced IGF I, that secretion varies between different placental zones which contain different cell types and that there are maturational changes in placental IGF I secretion. The IGFs may be involved in placental growth.

Animals↗

PubMed1991

Perifused ovine placental tissue secretes beta-endorphin immunoreactivity.

In vitro release of one of the pro-opiomelanocortin (POMC)-derived peptides, the endogenous opioid beta-endorphin (beta EP) has been examined in the sheep placenta by means of a perifusion system. Two zones of the cotyledon, the chorionic villus (highly vascularized fetal and maternal tissues in close apposition) and the maternal basal plate (or capsule), were examined in placenta at two stages of gestation--120 days (119.0 +/- 4.7, N = 4) and 140 days (143 +/- 1.8, N = 5) just before term. The chorionic villous tissue released more beta EP-like immunoreactivity (beta EP-IR) than did the basal plate tissue at both gestational ages. At 120 days' gestation the basal concentration of beta EP-IR released from the chorionic villus was 52 +/- 0.5 fmol mL-1 (n = 4), almost double the maternal basal plate tissue at 28.4 +/- 0.4 fmol mL-1 (n = 8). beta EP-IR secretory capacity increased significantly (P less than 0.05) with advancing gestational age. By Day 140, release had increased 3-4-fold to 181.8 +/- 0.8 fmol mL-1 (n = 16) in the chorionic villous tissue, and to a lesser extent in the basal plate tissue to 50.7 +/- 0.6 fmol mL-1 (n = 14). No stimulation of beta EP-IR secretion was observed in any tissue as a result of 30 min exposure to corticotrophin-releasing hormone (100 nmol L-1), a vital physiological secretagogue.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

Self report and performance-based hand function tests as correlates of dependency in the elderly.

Preventing or minimizing functional dependency in older adults rests, in part, upon the ability to predict who is at risk. The purpose of this study was to compare the ability of five tests of hand function to discriminate the degree of dependency in older adults. Seven hundred sixty four subjects were assessed for hand function on performance-based (Williams Test of Hand Function, a test of Williams Board items only, Jebsen Test of Hand Function, grip strength), and self-reported (Dexterity Scale of the Geriatrics-Arthritis Impact Measurement Scale (GERI-AIMS] measures of hand function, and self-reported multidimensional functional status (GERI-AIMS). A trichotomous variable representing a continuum of dependency based upon living site (independent living, home-bound, institutional) was used as the measure of dependency. Sixty-two cases were dropped for incomplete data. Discriminant function analyses of the 702 subjects (age X = 76.78 years, SD = 8.79) showed that basic demographic variables explain 40.8% of the variance in dependency; all hand function tests significantly correlated with dependency; the Williams Board correlated best (additional 12.5% variance explained). However, a multidimensional functional status measure explains substantially more variance in dependency (16.9%) after controlling for demographic variables and performance on the Williams Board. This comparison of methods and tests available for measuring hand function was made to provide criteria for selecting an instrument for a given setting.

Activities of Daily Living↗

PubMed1990

Intracellular mechanisms governing the acute phase of beta-endorphin secretion from the corticotrope in vitro.

It is not certain which protein kinase (A, C or both) is involved in the acute phase of beta-endorphin (beta-EP) release stimulated in the corticotrope by vasopressin (VP) and corticotropin-releasing factor (CRF). We have employed an isolated ovine anterior pituitary cell superfusion system to determine the dynamic effects of forskolin, a protein kinase A (PKA) stimulator, and phorbol 12-myristate 13-acetate (PMA), a protein kinase C (PKC) activator. Both secretagogues stimulated beta-EP release within 5 min and therefore both PKA and PKC are potential mediators of the acute phase of hormonal stimulation of the corticotrope. Pretreatment with PMA specifically desensitized the pituitary cell columns to subsequent PMA exposure while not significantly altering sensitivity to forskolin or 50 mM KCl.

Animals↗

PubMed1990

PET, CT, and MRI imaging of neuronal migration anomalies in epileptic patients.

During the investigation of intractable epilepsy, neuronal migration anomalies [NMA] were discovered in three patients. The first patient had abnormally positioned gray matter within the walls of both lateral ventricles. The second patient had a post operative cystic area in the right parietal-occipital lobes and an area of NMA within the right temporal lobe. The third patient had abnormally thickened gray matter in the right operculum. Long term CCTV-EEG monitoring of these three patients revealed ictal discharges originating from the area of abnormal gray matter in patients 2 and 3. PET scanning showed the areas of NMA in all three patients to have similar metabolic activity to normal gray matter. These cases illustrate the value of various imaging modalities and suggest some interesting physiology of a spectrum of neuronal migration anomalies.

Adolescent↗

PubMed1990

The effect of maternal ethanol infusion on placental blood flow and fetal glucose metabolism in sheep.

Intravenous infusion of 1 g ethanol/min over 1 hr to seven catheterised pregnant ewes decreased blood flow on both sides of the placenta. The reductions in blood flow were maintained for at least 2 hr after the infusion of ethanol had ceased. Although blood flow was reduced, fetal blood gases were unchanged. Plasma glucose concentrations were unchanged by ethanol, but fetal glucose supply and consumption were both decreased following maternal ethanol infusions. If maintained by chronic alcohol consumption these changes could contribute to the growth retardation seen in the Fetal Alcohol Syndrome.

Animals↗

PubMed1990

Prerandomization: an alternative to classic randomization. The effects on recruitment in a controlled trial of arthroscopy for osteoarthrosis of the knee.

Possibly the greatest threat to the success of a randomized clinical trial is the inability to recruit an adequate number of subjects. Concern that the randomized clinical trial will adversely affect the physician-patient relationship is the most common reason for physicians' reluctance to enroll patients in such trials. We report a modification of a prerandomized design, first described by Zelen, which was implemented in a randomized clinical trial of arthroscopy for patients who had osteoarthrosis of the knee. The method was associated with a sixfold increase in the rate of accrual of patients as compared with the use of a classic randomization trial. We propose the design as a potential solution to the problem of recruitment of subjects, particularly for clinical studies.

Arthroscopy↗

PubMed1990

Therapeutic ultrasound in the treatment of musculoskeletal conditions.

This paper presents a quantitative synthesis of the literature addressing the effectiveness of ultrasound in selected musculoskeletal conditions. Pain and range of motion appear to improve following ultrasound treatment in acute periarticular inflammatory conditions and osteoarthritis, but not in chronic periarticular inflammatory conditions. Placebo response and experimenter expectancy bias can not be ruled out as explanations for the positive results. The literature concerning the therapeutic efficacy of ultrasound for pain and immobility in musculoskeletal conditions is therefore inconclusive. Well-designed clinical trials are needed to resolve this question.

Bone Diseases↗

PubMed1989

Glucose metabolism in pregnant sheep when placental growth is restricted.

The effect of restricting placental growth on glucose metabolism in pregnant sheep in late gestation was determined by primed constant infusions of D-[U-14C]- and D-[2-3H]glucose and antipyrine into fetuses of six control sheep and six sheep from which endometrial caruncles had been removed before pregnancy (caruncle sheep). In the latter, placental and fetal weights were reduced, as was the concentration of glucose in fetal arterial blood. Fetal glucose turnover in caruncle sheep was only 52-59% of that in controls, largely because of lower umbilical loss of glucose back to the placenta (38-39% of control) and lower fetal glucose utilization (61-74% of control). However, fetal glucose utilization on a weight-specific basis was similar in control and caruncle sheep. Significant endogenous glucose production occurred in control and caruncle fetal sheep. Maternal glucose production and partition of glucose between the gravid uterus and other maternal tissues were similar in control and caruncle sheep. In conclusion, when placental and fetal growth are restricted, fetal glucose utilization is maintained by reduced loss of glucose back to the placenta and mother and by maintaining endogenous glucose production.

Animals↗

PubMed1989

Restriction of placental growth in sheep enhances placental metabolism of fetal beta-endorphin-like immunoreactivity.

The opioid polypeptide beta-endorphin is present in fetal blood but it is not clear whether its source is the fetus or the placenta. We therefore measured beta-endorphin in extracts of fetal femoral arterial and umbilical venous blood plasma in sheep by radioimmunoassay to determine whether the fetus or the placenta is the major source of beta-endorphin in the fetal circulation. Chromatographic analysis of extracts of fetal arterial plasma showed that beta-lipotropin and other precursors of beta-endorphin made only a minor contribution to the immunoreactivity detected. Concentrations of immunoreactive beta-endorphin were higher in the femoral artery than in the umbilical vein in fetal sheep between 113 and 128 days of pregnancy. Therefore the placenta removes beta-endorphin or a closely related polypeptide of fetal origin from the umbilical circulation in sheep at this stage of gestation. Acute hypoxaemia and hypoglycaemia increase the concentrations of immunoassayable beta-endorphin in blood plasma of adult and fetal sheep, but little is known about the effects of chronic hypoxaemia or hypoglycaemia on the circulating levels of beta-endorphin and related polypeptides in the fetus. Therefore we also measured immunoreactive beta-endorphin in blood plasma from fetal sheep in which growth retardation in association with restricted placental growth was produced by removal of endometrial caruncles before mating. Intra-uterine growth retardation was accompanied by chronic hypoglycaemia and chronic hypoxaemia in the fetuses. This was not associated with higher concentrations of beta-endorphin-like immunoreactivity in fetal arterial or umbilical venous plasma, but was accompanied by significantly increased placental extraction of fetal immunoreactive beta-endorphin from the umbilical circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1988

Differential processing of corticotrophin-releasing hormone by the human placenta and hypothalamus.

The molecular forms of corticotrophin-releasing hormone (CRH) in human placentae and hypothalami were investigated by gel permeation chromatography of water extracts. Hypothalamic extracts produced one peak of immunoreactivity which coeluted with human CRH at Kd = 0.53. Placental extracts, however, had in addition to that peak, two other peaks eluting earlier at the void and at Kd = 0.35-0.38. Tryptic digestion of the middle peak produced immunoreactivity which coeluted with the standard. Larger forms were also found in plasma of women in the third trimester of pregnancy and during labour but not in eluates from superfused placental fragments which had only CRH41-sized material. These data indicate that tissue-specific post-translational processing occurs for CRH, and suggests that the link between synthesis and secretion is more immediate in the placenta than hypothalamus.

Chromatography, Gel↗

PubMed1988

The effect of repetitive haemorrhage on plasma cortisol, beta-endorphin and N-terminal pro-opiomelanocortin in conscious sheep.

We measured the effect of repeated haemorrhagic stress, performed on four consecutive days in conscious adult sheep, on the plasma concentrations of cortisol and ACTH-related peptides to determine whether the pituitary-adrenal response was altered by stress repetition. Peptides from the C-terminus of the ACTH pro-hormone was measured by beta-endorphin RIA. Glycopeptides derived from the N-terminus of the ACTH pro-hormone were measured by tau 3-MSH RIA. The immunoreactive tau 3-MSH in sheep plasma was found to have an apparent molecular weight of approximately 10,000 by gel chromatography through Sephadex G-75, which is similar to the size of the major circulating form of pro-tau-MSH found in human and rat plasma. Daily haemorrhage consistently elevated plasma concentrations of cortisol and pro-tau-MSH. There was no significant difference in the daily responses of either cortisol or pro-tau-MSH when considered individually. However, there was a significant change over the four days in the relationship between the cortisol and pro-tau-MSH responses, as judged by analysis of variance of the difference in daily z-scores of cortisol and pro-tau-MSH. This trend indicated a relative increase in the secretion of pro-tau-MSH from the pituitary compared to the cortisol response, and suggested that repeated exposure to stressful stimuli may alter the pituitary-adrenal-axis.

Animals↗

PubMed1988

Immunoreactive methionine-enkephalin in cerebrospinal fluid and blood plasma during acute stress in conscious sheep.

The opioid peptide methionine-enkephalin (Met-enkephalin) was measured in plasma and cerebrospinal fluid (CSF) of sheep in which the cisterna magna, carotid artery, and jugular vein were chronically cannulated. Venous blood plasma and CSF were collected before and after stress treatment and in control studies in conscious animals. Plasma and CSF were extracted with octadecylsilica and oxidized, and Met-enkephalin was measured as its Met-sulfoxide derivative by specific RIA. The molecular form of immunoreactive Met-enkephalin was characterized by peptide size exclusion chromatography of an octadecylsilica extract of sheep plasma through Bio-Gel P2, followed by reverse phase liquid chromatography, and was identical to Met-enkephalin and Met-sulfoxide-enkephalin. Insulin-induced hypoglycemia produced an elevation of plasma cortisol and an increase in the plasma concentration of Met-enkephalin. Acute hemorrhage led to an earlier and greater rise in plasma cortisol than that associated with insulin-induced hypoglycemia, but did not increase the concentration of Met-enkephalin in plasma. Neither form of acute stress increased the concentration of Met-enkephalin in CSF. These studies confirm that secretion of Met-enkephalin into blood can be dissociated from stimulation of the pituitary-adrenocortical system. They also show that circulating Met-enkephalin is elevated in conscious sheep during acute hypoglycemic stress, but plasma Met-enkephalin is unlikely to exert effects on the opiate receptors of periaqueductal or spinal nociceptive neurons under these conditions, since it does not enter cerebrospinal fluid in significant amounts.

Animals↗

PubMed1988

Secretion of beta-endorphin into the maternal circulation by uteroplacental tissues in response to hypoglycaemic stress.

The placenta has been shown to contain ACTH and beta-endorphin but the roles of these peptides are unknown. To investigate whether they are released into the maternal circulation from the placenta in response to physiological stimuli the effects of hypoglycaemic stress were investigated. Plasma samples were collected from the femoral artery (FA) and uterovarian (UV) vein of nine pregnant sheep before and during hypoglycaemia induced by intravenous insulin (100U). Plasma concentrations of ovine beta-endorphin (o beta-EP) were measured by radioimmunoassay. Concentrations of o beta-EP rose in both vessels by 60 min after insulin. The peak concentrations of o beta-EP (pmol/l) were 122 +/- 29 (mean +/- SEM, n = 8) in the UV and 96 +/- 24 (n = 9) fmol/ml in the FA 60 min after insulin injection. There was no difference between the concentrations of o beta-EP in the vessels before insulin injection but at 60 and 120 min after insulin the concentrations of o beta-EP were significantly higher in the UV than FA (P less than 0.02, analysis of variance). This indicates that the pregnant uterus or placenta can respond to hypoglycaemia by secreting beta-EP into the maternal circulation. It is therefore possible that placental pro-opiomelanocortin (POMC) peptides may have a role in maternal endocrinology and metabolism.

Animals↗

PubMed1988

Secretion of corticotropin-releasing hormone by superfused human placental fragments.

Corticotropin-releasing hormone (CRH) immunoreactivity (IR) is present in the blood of women in the 3rd trimester of pregnancy and in placental extracts. We have used a placental fragment superfusion system to investigate the release of CRH from fresh placental tissue. Fragments of normal term placenta were mixed with Biogel P2, packed into minicolumns and superfused with carbogen-gassed Earles buffer at 37 degrees C. The rheology of the superfusion system was determined and the oxygen consumption of the superfused placental fragments indicated viability of the tissue preparation over a 5-hour time span. CRH IR in the eluate was measured by radioimmunoassay (RIA) using the 41 residue synthetic peptide human, rat CRH-41 (h, r CRH-41) as the standard, 125I labelled Tyr- h, r CRH as the tracer and rabbit anti-ovine CRH as the antibody. The sensitivity of the assay is 2 pM. Size exclusion chromatography on Sephadex G-50 of the placental column eluate displayed one major peak of CRH IR which co-eluted with that of h, r CRH. Placental fragment superfusate displayed potent CRH bioactivity as assessed by beta-endorphin secretion from ovine pituitary cells. Replacing the superfusing medium of the placental fragments with 45 mM KCl resulted in a prompt increase in the release of CRH IR. These results indicate that placental cells in vitro secrete a molecule of similar molecular weight, immunoreactivity and bioactivity to h, r CRH and that the rate of secretion may be regulated.

Animals↗