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Biomedical subjects

J Hardy

Publications and source records attributed to J Hardy.

At least 19 recordsLinked to original sources

Segmental uniparental isodisomy on 5q32-qter in a patient with childhood-onset schizophrenia.

Schizophrenia is a severe mental disorder affecting approximately 1% of the world's population. Although the aetiology of schizophrenia is complex and multifactorial, with estimated heritabilities as high as 80%, genetic factors are the most compelling. Childhood-onset schizophrenia (COS), defined as onset of schizophrenia before the age of 13 years, is a rare and malignant form of the illness that may have more salient genetic influence. The first known case of paternal segmental uniparental isodisomy (iUPD) on 5q32-qter in a patient with COS is described, which adds to the previously known high rates of chromosomal abnormalities reported in this sample. iUPD is a rare genetic condition in which the offspring receives two chromosomal homologues from one parent. Segmental UPD is defined as UPD on a portion of a chromosome with biparental inheritance seen in the rest of the homologous pair. Complications owing to this abnormality may arise from malfunctioning imprinted genes or homozygosity of recessive disease-causing mutations. This aberration became apparent during whole-genomic screening of a COS cohort and is of particular interest because 5q has been implicated in schizophrenia by several genomewide linkage studies and positive gene associations. This report, therefore, presents more evidence that schizophrenia susceptibility gene, or genes, may be found on distal 5q.

Adolescent↗

Surface composition of dairy powders observed by X-ray photoelectron spectroscopy and effects on their rehydration properties.

The surface composition of three dairy powders was investigated by X-ray photoelectron spectroscopy. These spray-dried casein powders were more or less enriched in hygroscopic material (lactose and/or minerals). The principal limitation of these high protein content powders is their poor rehydration ability. Consequently, information about surface composition is required in order to get a better understanding of rehydration behaviour (i.e. wetting time and time of rehydration). The obtained results indicate that the surface of the three powders was dominated by proteins. Lactose and minerals are marginal compounds at the surface whereas the surface coverage of fat was over represented. A correlation between the lactose surface content and the wetting time of the powders was found, but no relationship with the surface fat. Moreover, as the surface is partly depleted in minerals and lactose, it is concluded that these compounds are principally located in the bulk of the particle. Therefore this observation could be related with a wetting time of the powders only slightly affected by the addition of hygroscopic material whereas the time of rehydration was strongly improved; powder wetting being more affected by the surface composition whereas powder dispersion being more influenced by the powder bulk composition.

Caseins↗

Propagation of mechanical waves in a one-dimensional nonlinear disordered lattice.

The propagation of transverse waves along a string loaded by masses, each of them being fixed to a spring with a quadratic nonlinearity, is studied. After presenting the nonlinear model and stating the equation of propagation into a lattice with discrete nonlinearities and disorder, we propose a perturbation approach to wave propagation in a nonlinear lattice using the Green's function formalism. We show how the nonlinearity acts on the propagation into a disordered lattice. In the low-frequency approximation, an analytical expression of the boundary between the propagative regime and the evanescent one is found. Numerical results are compared to the analytical results and phase diagrams are proposed in the ordered and disordered cases. A behavior of the transmission coefficient is found, on an empirical basis, as a function of the length of the lattice and the localization length in the nonlinear case. Finally, a dynamic approach is developed and the ordered and disordered cases are addressed. This method is based on a finite difference equation and allows the construction of the Poincaré section describing the propagation of the wave into the lattice. This approach distinguishes between the properties of propagation in the lattice in a propagative regime and in an evanescent one.

Journal Article↗

Consent for investigating and treating adults with cancer.

The importance of the consenting process, as a key activity in patient care, has been recognised by the Department of Health with the production of a policy aimed at ensuring patient focused national standards. Cancer treatments are complex and multi-disciplinary encompassing difficult issues around outcomes and toxicity. This article looks at the process within the UK Cancer network and addresses some of the situations which occur in clinical practice. Examples of difficult scenarios are given to illustrate the application of the basic principles.

Adult↗

An evaluation of emergency medicine investigators' views on open access to medical literature.

BACKGROUND: Scientists and governmental agencies have called for free universal access to research publications via the internet--open access. OBJECTIVES: To examine the current medical literature reading practices of emergency medicine investigators (EMIs) and their views towards open access. METHODS: Surveys were mailed to the 212 corresponding authors of all original research articles published in years 2002 and 2003 in the Annals of Emergency Medicine, Academic Emergency Medicine and The Journal of Emergency Medicine. RESULTS: The most commonly read forms of medical literature reported by the 129 (61%) EMI respondents were hard-copy medical journals and online literature review services. 59% of EMIs were in favour of open access; 58% stated they would read a wider variety of medical literature; 21% believed open access would improve the quality of publications and 39% thought it would decrease the quality. When asked how a US 1500 dollars fee for open access would affect their ability to publish research, 69% said it would greatly impede and 19% said it would slightly impede their research. CONCLUSIONS: Despite concerns that open access may impede their ability to publish research and decrease the quality of publications, most EMIs surveyed favoured open access. They believed open access would increase and broaden their medical literature reading.

Adult↗

Association of tau haplotype-tagging polymorphisms with Parkinson's disease in diverse ethnic Parkinson's disease cohorts.

BACKGROUND: The overlap in the clinical and pathological features of tauopathies and synucleinopathies raises the possibility that the tau protein may be important in Parkinson's disease (PD) pathogenesis. Several MAPT polymorphisms that define the tau H1 haplotype have been investigated for an association with PD with conflicting results; however, two meta-analyses support an association between haplotype H1 and PD. METHODS: In this study, we recruited 508 patients and 611 healthy controls from Greek, Finnish and Taiwanese populations. We examined the possible genetic role of variation within MAPT in PD using haplotype-tagging single polymorphisms (SNPs) in these ethnically different PD populations. RESULTS: We identified a moderate association at SNP rs3785883 in the Greek cohort for both allele and genotype frequency (p = 0.01, p = 0.05, respectively) as well as for SNP rs7521 (genotype p = 0.02) and rs242557 (p = 0.01 genotypic, p = 0.04 allelic) in the Finnish population. There were no significant differences in genotype or allele distribution between cases and controls in the Taiwanese cohort. CONCLUSION: We failed to demonstrate a consistent association between the MAPT H1 haplotype (delineated by intron 9 ins/del) and PD in three ethnically diverse populations. However, the data presented here suggest that subhaplotypes of haplotype H1 may confer susceptibility to PD, and that either allelic heterogeneity or different haplotype composition explain the divergent haplotype results.

Adult↗

Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium.

The dementia with Lewy bodies (DLB) Consortium has revised criteria for the clinical and pathologic diagnosis of DLB incorporating new information about the core clinical features and suggesting improved methods to assess them. REM sleep behavior disorder, severe neuroleptic sensitivity, and reduced striatal dopamine transporter activity on functional neuroimaging are given greater diagnostic weighting as features suggestive of a DLB diagnosis. The 1-year rule distinguishing between DLB and Parkinson disease with dementia may be difficult to apply in clinical settings and in such cases the term most appropriate to each individual patient should be used. Generic terms such as Lewy body (LB) disease are often helpful. The authors propose a new scheme for the pathologic assessment of LBs and Lewy neurites (LN) using alpha-synuclein immunohistochemistry and semiquantitative grading of lesion density, with the pattern of regional involvement being more important than total LB count. The new criteria take into account both Lewy-related and Alzheimer disease (AD)-type pathology to allocate a probability that these are associated with the clinical DLB syndrome. Finally, the authors suggest patient management guidelines including the need for accurate diagnosis, a target symptom approach, and use of appropriate outcome measures. There is limited evidence about specific interventions but available data suggest only a partial response of motor symptoms to levodopa: severe sensitivity to typical and atypical antipsychotics in approximately 50%, and improvements in attention, visual hallucinations, and sleep disorders with cholinesterase inhibitors.

Brain↗

Load transmission through a healing tibial fracture.

BACKGROUND: Fracture healing has been linked to both the magnitude and distribution of mechanical stresses on the healing fracture tissues. However, direct clinical measurement of in vivo tibial axial loading is not possible. METHODS: Using computed tomography images, force plate data and recorded 3D interfragmentary micromovements, accurate 3D finite element models of a healing human tibial fracture were generated at 7, 10, and 16 weeks post-fracture and used to calculate longitudinal tibial forces and external fixator load-sharing during bilateral stance and walking. FINDINGS: Tibial load-sharing by the fixator decreased significantly as the fracture tissues developed even moderate stiffness, while tibial load increased steadily towards normal. INTERPRETATION: Quantitative assessment of the contribution of the external fixator is important as overloading of the callus due to insufficient support has been implicated in the retardation of the healing process.

Adult↗

The H1c haplotype at the MAPT locus is associated with Alzheimer's disease.

Although it is clear that microtubule associated protein tau (MAPT) is involved in Alzheimer's disease (AD) pathology, it has not been clear whether it is involved genetically. We have recently examined the MAPT locus in progressive supranuclear palsy and found that a haplotype (H1c) on the background of the well-described H1 clade is associated with PSP. Here we report that the same haplotype is associated with the risk of AD in two autopsy confirmed series of cases with ages at death >65 years.

Aged↗

Experience in the use of the palliative care outcome scale.

GOALS OF WORK: The objective of the study is to assess the Palliative Care Outcome Scale (POS) as a potential audit tool within a specialist cancer centre. It also aims to answer the following questions: does the tool identify problem areas and demonstrate changes in quality of life over time? How well do staff and patient ratings correlate? PATIENTS AND METHODS: The POS questionnaire was piloted at a specialist cancer centre. Thirty consecutive patients admitted to the palliative care wards and ward staff completed questionnaires on admission and twice weekly until discharge or death. A further questionnaire assessed staff attitudes. RESULTS: There was a significant improvement in overall patient POS score at 1 week (days 5-9). Four "symptoms" or issues were scored as being important for our patients: pain, other symptoms, anxiety and patient's perception of family anxiety. These all significantly improved within the first week. At the initial assessment, staff underestimated patients' pain and overestimated problems relating to information giving and patients' ability to share their feelings. There was no significant difference between staff and patient scores after 1 week. The other six areas covered by the tool were less important; this may reflect the patient population seen at our centre. Use of the tool identified areas for staff training and effectively demonstrated improvement in patient care. CONCLUSION: The POS is an outcome measure tool designed to assess physical, psychological, practical and existential aspects of quality of life. It may be useful in identifying problems in individual patients and directing care to address these needs.

Adult↗

Linkage disequilibrium fine mapping and haplotype association analysis of the tau gene in progressive supranuclear palsy and corticobasal degeneration.

BACKGROUND: The haplotype H1 of the tau gene, MAPT, is highly associated with progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). OBJECTIVE: To investigate the pathogenic basis of this association. METHODS: Detailed linkage disequilibrium and common haplotype structure of MAPT were examined in 27 CEPH trios using validated HapMap genotype data for 24 single nucleotide polymorphisms (SNPs) spanning MAPT. RESULTS: Multiple variants of the H1 haplotype were resolved, reflecting a far greater diversity of MAPT than can be explained by the H1 and H2 clades alone. Based on this, six haplotype tagging SNPs (htSNPs) that capture 95% of the common haplotype diversity were used to genotype well characterised PSP and CBD case-control cohorts. In addition to strong association with PSP and CBD of individual SNPs, two common haplotypes derived from these htSNPs were identified that are highly associated with PSP: the sole H2 derived haplotype was underrepresented and one of the common H1 derived haplotypes was highly associated, with a similar trend observed in CBD. There were powerful and highly significant associations with PSP and CBD of haplotypes formed by three H1 specific SNPs. This made it possible to define a candidate region of at least approximately 56 kb, spanning sequences from upstream of MAPT exon 1 to intron 9. On the H1 haplotype background, these could harbour the pathogenic variants. CONCLUSIONS: The findings support the pathological evidence that underlying variations in MAPT could contribute to disease pathogenesis by subtle effects on gene expression and/or splicing. They also form the basis for the investigation of the possible genetic role of MAPT in Parkinson's disease and other tauopathies, including Alzheimer's disease.

Aged↗

An open study of methotrimeprazine in the management of nausea and vomiting in patients with advanced cancer.

INTRODUCTION: Nausea and vomiting are distressing symptoms affecting between 20% and 70% of patients with advanced cancer. Methotrimeprazine is a phenothiazine antipsychotic used in palliative care for the management of terminal agitation and nausea/vomiting but there is only anecdotal evidence to support its use in palliative care. AIM: To establish whether nausea/vomiting in palliative care patients is improved by the administration of low-dose methotrimeprazine. METHODS: Patients with advanced malignancy were entered at different treatment levels according to symptom severity. The dose was altered according to response (minimum dose 6.25 mg daily po, maximum 25 mg by 24-h subcutaneous infusion). Symptoms and side effects were recorded daily from 0 (baseline) to day 5 using a four-point scale. Any improvement in nausea/vomiting score was taken as a response. RESULTS: Sixty-five patients were entered. The cause of nausea and vomiting was multifactorial in the majority of patients, 35/65 (54%). As expected in a study of patients with poor performance status, the attrition rate was high. Of 53 patients evaluable for response at day 2, 33 (62%) showed some improvement in nausea or vomiting. At day 5, improvement was seen in 20/34 (58%). There was no significant change in "side effects" from baseline with time. CONCLUSION: These results suggest that methotrimeprazine has antiemetic activity.

Adult↗

An African American family with early-onset Alzheimer disease and an APP (T714I) mutation.

The occurrence of an APP T174I mutation is described in a large American family of African descent with Alzheimer disease. The clinical characteristics were an unusually early onset of disease (early 30s), similar to a previously reported age at onset of this mutation in an Austrian family. Distinct from that family, seizures and myoclonus were prominent features of the disease in this kindred.

Adult↗

Expression of normal sequence pathogenic proteins for neurodegenerative disease contributes to disease risk: 'permissive templating' as a general mechanism underlying neurodegeneration.

Loci underlying autosomal dominant forms of most neurodegenerative disease have been identified: prion mutations cause Gerstmann Straussler syndrome and hereditary Creutzfeldt-Jakob disease, tau mutations cause autosomal dominant frontal temporal dementia and alpha-synuclein mutations cause autosomal dominant Parkinson's disease. In these cases, the pathogenic mutation is in the protein that is deposited in the diseased tissue and the whole protein is deposited. In Alzheimer's disease, mutations in amyloid precursor protein or in the presenilins cause autosomal dominant disease. These are the substrate and proteases responsible for the production of the deposited peptide Abeta. Thus, in all the cases, the mutations lead to the disease by a mechanism that involves the deposition process. Furthermore, sporadic forms of all these diseases are predisposed by genetic variability at the same loci, implying that the quantity of the normal protein influences the risk of this form of disease. These results show that the amount of pathogenic protein expression is a key factor in determining disease initiation. Recent work on transgenic models of these diseases is consistent with the view that there are two stages of pathogenesis: a concentration-dependent formation of a pathogenic protein oligomer followed by aggregation on to this oligomeric template by a process that is less dependent on the concentration of the protein.

Alzheimer Disease↗

Evidence suggesting that Homo neanderthalensis contributed the H2 MAPT haplotype to Homo sapiens.

The tau (MAPT) locus exists as two distinct clades, H1 and H2. The H1 clade has a normal linkage disequilibrium structure and is the only haplotype found in all populations except those derived from Caucasians. The H2 haplotype is the minor haplotype in Caucasian populations and is not found in other populations. It shows no recombination over a region of 2 Mb with the more common H1 haplotype. The distribution of the haplotype and analysis of the slippage of dinucleotide repeat markers within the haplotype suggest that it entered Homo sapiens populations between approx. 10000 and 30000 years ago. However, sequence comparison of the H2 haplotype with the H1 haplotype and with the chimp sequence suggests that the common founder of the H1 and H2 haplotypes was far earlier than this. We suggest that the H2 haplotype is derived from Homo neanderthalensis and entered H. sapiens populations during the co-existence of these species in Europe from approx. 45000 to 18000 years ago and that the H2 haplotype has been under selection pressure since that time, possibly because of the role of this H1 haplotype in neurodegenerative disease.

Animals↗

Gabapentin is effective in the treatment of cancer-related neuropathic pain: a prospective, open-label study.

BACKGROUND: Gabapentin has been evaluated in the treatment of nonmalignant neuropathic pain, however, there is little direct evidence evaluating its efficacy in cancer-related neuropathic pain. OBJECTIVE: This study evaluated the effectiveness of gabapentin to treat cancer-related neuropathic pain. DESIGN: This was an open-label study. Two parallel groups of patients were recruited with either treatment-related (radiotherapy, surgery, chemotherapy) or tumor-related neuropathic pain. Gabapentin was dose-escalated from 300 mg/d to 1.8 g/d. MEASUREMENTS: The primary outcome, pain, was assessed using the modified brief pain inventory. In addition patient descriptors of pain and scores of activities of daily living were collated together with demographic data. RESULTS: We recruited 62 patients with treatment-related (n = 25) or tumor-related (n = 37) neuropathic pain. There was a significant reduction in the worst, average, and current pain scores (p < 0.002), but not the least pain score (p = 0.21). Twenty-eight of 62 (45.2%) of patients achieved at least a one third reduction in pain score (95% confidence interval [CI] 32.5-58.3); the number needed to treat to obtain this benefit is 2.2 (95% CI 1.7-3.1). There was a significant reduction in all scores measuring the impact of pain on daily living (p < 0.003). There was no significant difference in pain scores at day 8 compared to day 15. Analysis of variance suggested that gender, but not etiology, or type of neuropathic pain, was a significant predictor of analgesic response and this warrants further investigation. CONCLUSION: We conclude that gabapentin is an effective treatment for cancer-related neuropathic pain.

Aged↗