Biomedical subjects
L Sullivan
Publications and source records attributed to L Sullivan.
In the path of Daedalus: middle-class Australians' attitudes to embryo research.
In the Australian debate over the permissability of embryo experimentation, four lobby groups are equally divided into supporting and opposing parties, although for differing reasons. The scientific and the infertile women's lobbies support experimentation while the pro-life and feminist lobbies oppose it, and the recommendations of committees of enquiry as to a proper legal position tend to reflect representation of these groups in their memberships. Community opinion is often invoked as a way out of this stalemate, but little is yet known of levels of community support for the opposing views. The present survey elicited the views of middle-class Australians (345 respondents) on the acceptability of in vitro fertilization (IVF) and embryo experimentation, and on the humanity of the embryo. It was found that while there was almost consensus support for IVF (90 per cent approval in principle), little more than half the respondents approved of embryo experimentation on the just-fertilized one-cell embryo, and this fell to only a third for the fourteen day embryo. This was despite the fact that more respondents regarded the embryo of a few days old as 'object/tissue' than as 'human/a baby'. Disapproval of embryo experimentation was more strongly associated with female sex, younger age, and fertility than with male sex, older age and infertility. Implications for the ethics of research policy are discussed.
AIDS--beyond education.
Explore the source record for details and available documents.
Electromyographic registration of diaphragmatic fatigue during sustained trunk flexion in cervical cord injured patients.
When performing forward trunk flexion, cervical cord injured (CCI) patients exhibit continuous and high EMG activity in the diaphragm and elevated abdominal pressures. This study addressed the question whether the trunk flexion manoeuvres cause such a high force development in the diaphragm that this muscle shows EMG signs of fatigue. Six patients with complete cervical cord lesions were tested sitting in their own wheelchairs. The tension-time indices obtained when patients were sitting in a relaxed position were moderately to markedly higher than in normal subjects. The force developed during trunk flexion averaged 30% of the maximal transdiaphragmatic pressure and was accompanied by clear EMG findings of diaphragmatic fatigue in all patients except one. The acute diaphragmatic load in certain CCI patients may well produce ischaemia and increase the risk of tissue impairment. Therefore, there appears to be a need for differing strategies in the short and in the long term treatment of CCI patients; longitudinal evaluation of main diaphragmatic function may be useful for an adequate amount of respiratory muscle training.
The role of the diaphragm in trunk extension in tetraplegia.
Interest has been focused on the diaphragm as the all important respiratory muscle in tetraplegia for decades but its unique role as a trunk extension muscle has not been considered. This study set out to establish the relationship, if any, between the roles of the diaphragm during arm exercise and trunk flexion. Eight male complete cervical cord injuries (CCI) patients, sitting in their wheelchairs, were studied during rest, trunk flexion and start of arm cranking. The average flow, volume, oesophageal and gastric pressures (Poes and Pga) and the myoelectric activity of the diaphragm (EMGdi) were recorded. The EMGdi pattern changed from phasic activity at rest to continuous or almost continuous activity during trunk flexion. Patients were then either spontaneously holding their breath or breathing irregularly with rapid or shallow breaths. Also, the normalised EMGdi signal strength increased by an average of 150% and the mean Pga by about 3 kPa, while mean Poes decreased by about 0.5 kPa. At the start of exercise, patients with poor triceps function, less than MRC grade 3, exhibited similar ventilatory and EMGdi changes as had been seen in trunk flexion. In patients with better triceps function, only minor changes in these variables were observed. The findings suggest that the diaphragm acts both as a trunk extensor muscle and a respiratory muscle. During posture imbalance, the postural needs temporarily override the respiratory needs.
Interleukin-5 modulates eosinophil accumulation in allergic guinea pig lung.
Based on its involvement in eosinophil biology, interleukin 5 (IL-5) may play a role in the pulmonary eosinophilia associated with allergic reactions. We have examined that hypothesis using a neutralizing antibody to IL-5 in ovalbumin-sensitized guinea pigs challenged with aerosolized antigen. The extent of eosinophilia has been quantitated in bronchoalveolar lavage (BAL) and by histologic evaluation of lung tissue sections. Acute intraperitoneal administration of a rat IgG, monoclonal antibody to murine IL-5 derived from TRFK-5 cells prevented lung and BAL eosinophilia in a dose-dependent fashion at and above 10 micrograms per guinea pig. Treatment with either an experimentally irrelevant, isotype-matched antibody from GL113 cells or with heat-denatured IL-5 antibody was without effect. These studies demonstrate the importance of IL-5 to pulmonary eosinophilia in challenged, allergic guinea pigs.
Depression among caregivers of impaired elders.
Studies have reported that rates of depression among caregivers are higher than in the general population. However, these studies have been limited primarily to caregivers of cognitively impaired elders. Using the Center for Epidemiological Studies Depression (CES-D) Scale, this study investigated depression among caregivers for physically impaired elders. The authors found that one third of these caregivers reported depressive symptoms, a lower rate than for caregivers of cognitively impaired elders but still twice the rate for the general population. The data show that depressive symptoms are related primarily to health status but also to aspects of the caregiving situation, including both the negative impact of that care as well as the relationship of the caregiver to the frail elder. Depressive symptoms are not mediated by formal or informal support.
Planned homebirths in Western Australia.
Explore the source record for details and available documents.
From the Secretary of Health and Human Services.
Explore the source record for details and available documents.
IL-4 can correct defective IgE production in SJA/9 mice.
SJA/9 mice are unable to produce significant serum IgE responses to either primary or secondary challenge with protein Ag or helminth parasites. Previous work has shown that this defect resides the T cell rather than with the B cells. These experiments test several possible explanations for the lack of IgE production in these mice. SJA/9 mice do not appear to overproduce IFN-gamma or any other antagonist of IL-4 function. Helminth parasite infection induces normal levels of IL-5-dependent eosinophilia, suggesting that there is not a complete absence of a Th2 response in these mice. The defect, however can be explained by a substantial reduction in IL-4 production in vivo and can be corrected by infusion with IL-4. The reason for this lack of IL-4 production is not yet clear and, paradoxically, SJA/9 T cells can be stimulated in vitro to produce IL-4 levels comparable to T cells from other strains.
Effect of restricting dietary protein on the progression of renal failure in patients with insulin-dependent diabetes mellitus.
BACKGROUND: Restriction of dietary protein may slow the progression of renal failure in diverse renal diseases, but the extent to which such a diet is beneficial in patients with diabetic nephropathy is uncertain. METHODS: We studied the effect of reduced intake of protein and phosphorus on the progression of renal disease in 35 patients with insulin-dependent (Type I) diabetes mellitus and clinically evident nephropathy. The low-protein, low-phosphorus diet contained 0.6 g of protein per kilogram of ideal body weight per day, 500 to 1000 mg of phosphorus, and 2000 mg of sodium. The control diet consisted of the patient's prestudy diet with the stipulation that it contain 2000 mg of sodium and at least 1 g of protein per kilogram per day and 1000 mg of phosphorus. Renal function was assessed by measurement of iothalamate and creatinine clearances at intervals of 3 to 6 months, and the patients were followed for a minimum of 12 months (mean, 34.7). The declines in mean glomerular filtration rates were compared between groups by linear-regression analysis of the glomerular filtration rate as a function of time. RESULTS: The patients who followed the study diet for a mean of 37.1 months had declines in iothalamate clearance of 0.0043 ml per second per month and in creatinine clearance of 0.0055 ml per second per month. The comparable values in the control group were 0.0168 and 0.0135, respectively (P less than 0.05). Blood pressure was well controlled, and the degree of glycemic control was comparable in both groups. CONCLUSION: Dietary restriction of protein and phosphorus can retard the progression of renal failure in patients with Type I diabetes mellitus who have nephropathy. We believe that wider use of this treatment is indicated.
Pharmacology and toxicology of a liposomal formulation of amphotericin B (AmBisome) in rodents.
AmBisome is a lyophilized preparation of liposomal amphotericin B. The acute intravenous toxicity of AmBisome was evaluated in mice and rats, and the LD50S were found to be greater than 175 and 50 mg/kg, respectively. The corresponding LD50S for conventional amphotericin B were approximately 2.3 and 1.6 mg/kg for mice and rats, respectively. The multiple dose toxicity test confirmed that AmBisome was well tolerated by both species. There were no deaths observed among mice receiving 25 or 50 mg/kg AmBisome for 14 days, and only two deaths among mice receiving 75 mg/kg AmBisome. One rat died in the group receiving 25 mg/kg AmBisome for 30 days. However, five of ten and nine of ten rats died in the groups treated with 50 and 75 mg/kg AmBisome, respectively. Hepatotoxicity was evident by elevation in serum liver enzyme levels for these groups. Initial pharmacokinetic evaluations demonstrated that peak plasma concentrations of 87 and 118 mg/kg, respectively, were attained in mice and rats after injection with 5 mg/kg AmBisome. Terminal plasma half-lives of 3.36 and 7.56 h were calculated for mice and rats, respectively. Tissue accumulations of amphotericin B resulting from multiple dose intravenous administration of either conventional amphotericin B or AmBisome were determined. At equivalent doses of 1 mg/kg, AmBisome treatment resulted in higher liver and spleen uptake of drug, but lower kidney and lung uptake than amphotericin B. At 5 mg/kg, AmBisome treatment resulted in concentrations of drug in the kidney and lungs that were comparable to corresponding tissue levels observed in the group treated with 1 mg/kg conventional amphotericin B.(ABSTRACT TRUNCATED AT 250 WORDS)
Expression of adhesion molecules in leprosy lesions.
Leprosy presents as a clinical spectrum that is precisely paralleled by a spectrum of immunological reactivity. The disease provides a useful and accessible model, in this case in the skin, in which to study the dynamics of cellular immune responses to an infectious pathogen, including the role of adhesion molecules in those responses. In lesions characterized by strong delayed-type hypersensitivity against Mycobacterium leprae (tuberculoid, reversal reaction, and Mitsuda reaction), the overlying epidermis exhibited pronounced keratinocyte intracellular adhesion molecule 1 (ICAM-1) expression and contained lymphocytes expressing the ICAM-1 ligand, LFA-1. Conversely, in lesions in which delayed-type hypersensitivity was lacking (lepromatous), keratinocyte ICAM-1 expression was low and LFA-1+ lymphocytes were rare. Expression of these adhesion molecules on the cells within the dermal granulomas was equivalent throughout the spectrum of leprosy. The percentage of lymphocytes in these granulomas containing mRNA coding for gamma interferon and tumor necrosis factor alpha, synergistic regulators of ICAM-1 expression, paralleled epidermal ICAM-1 expression. In lesions of erythema nodosum leprosum, a reactional state of lepromatous leprosy thought to be due to immune complex deposition, keratinocyte ICAM-1 expression and gamma interferon mRNA+ cells were both prominent. Antibodies to LFA-1 and ICAM-1 blocked the response of both alpha beta and gamma delta T-cell clones in vitro to mycobacteria. Overall, the expression of adhesion molecules by immunocompetent epidermal cells, as well as the cytokines which regulate such expression, correlates with the outcome of the host response to infection.
Comparison of immunofluorescence and enzyme immunoassay for detection of measles-specific immunoglobulin M antibody.
During a measles outbreak, 283 serum specimens from 221 suspected cases of measles were tested by immunofluorescence and enzyme immunoassay for the presence of measles-specific immunoglobulin M (IgM) antibodies by using commercially available reagents. There was 97% agreement between the two assays; thus, the choice of the method for diagnostic testing is a matter of convenience and experience. In all 62 cases of measles from which a single blood sample was available, measles IgM-specific antibodies were detectable by both methods. Fifty percent of the 62 cases were positive within 3 days after onset of the rash. This increased to 91% 10 days after onset of the rash.
Surrogacy: the case for a conventional approach.
Legislation for the reproductive technologies made a false beginning when initial legislation chose to obscure the separation of genetic and social/legal parenthood resulting from the use of donor sperm and ova. This initial falsehood is compounding the difficulties of later attempts to deal with more complex issues. The NSW Law Reform Commission's arguments and recommendations with regard to surrogacy illustrate this problem. It is argued that legislation should work from precedent in matters of recognition and transfer of parenthood, and that the social ramifications of the new technologies should be identified as far as possible within existing social determinations. The nature of surrogacy and required legislation is explored in this context, and it is argued that surrogacy should be subject to essentially the same regulation as adoption, thus debarring commercialization but without legislative intervention into the area of private reproductive behaviour. It is suggested that such an approach will effectually discourage surrogacy as it provides no sureties for the 'commissioning' couple.
An opportunity to oppose: physicians' role in the campaign against tobacco.
Explore the source record for details and available documents.
Quality of semen after repeated ejaculation treatment in spinal cord injury men.
The study was designed to document the effects of regular drainage after penile vibrator stimulation on the quality of semen in SCI men. Twenty three tetraplegics and 9 paraplegics, 18 to 40 years of age and with neurological levels ranging from C4 to L1, were examined between 1 and 23 years after injury (median 2 years). None had ejaculated after the injury. Penile vibrator stimulation was tried in patients with cervical or thoracic lesions who showed reflex hip flexion on scratching the soles of the feet, 29 out of 32, and rectal electrostimulation in the remaining 3 low lesions with no reflex function in lumbar and sacral segments. The stimulation yielded semen in 29 (91%) of the men; 22 had antegrade and 7 retrograde ejaculation. Sixteen of the 22 patients with antegrade ejaculation entered a home programme of vibrator stimulation prescribed once weekly. Four to 6 months of stimulation resulted in a rise of semen volume and of fructose and acid phosphatase levels in the seminal plasma, suggesting improved function of the seminal vesicles and the prostate. The percentage of motile sperms was low both before and after the treatment period. Despite this, the total count of motile sperms per ejaculate was already high in the patient's first ejaculates compared to the laboratory normal standard, and further clearly increased after the stimulation period. A standardised functional test measuring sperm penetration capacity showed strong evidence of long term stimulation effect. It is suggested that the test is used in the assessment of fertility potential in SCI men.
Sexual ability, activity, attitudes and satisfaction as part of adjustment in spinal cord-injured subjects.
Changes in different aspects of sexuality were investigated and related to overall quality of life and physical, psychological and social adjustment in 73 SCI subjects, who were sexually active both before and after injury. Items on sexual interest and satisfaction were treated as one composite variable, the SIS scale, measuring sexual adjustment after injury. Despite severe genital dysfunction, more than half of the subjects (57%) rated their sexual relations after injury as satisfying or at least rather satisfying. The majority continued having intercourse, although many of them more seldom than before, and about half experienced orgasm. Sexual adjustment after injury was closely and positively correlated to frequency of intercourse, willingness to experiment with alternative sexual expressions and young age at injury. Physical and social independence and a high mood level were further positive determinants of sexual adaptation after injury, whereas the neurological level and completeness of injury showed no significant correlation with sexuality. It is suggested that sexual information and counselling should be integrated in the total care of the SCI patient to reduce the negative effects on sexuality, caused by the injury.