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Biomedical subjects

Michael J Sheridan

Publications and source records attributed to Michael J Sheridan.

At least 19 recordsLinked to original sources
PubMed2006

Physiological and serological variation in Streptococcus mitis biovar 1 from the human oral cavity during the first year of life.

OBJECTIVE: The purpose of the study was to explore the physiological and antigenic diversity of a large number of Streptococcus mitis biovar 1 isolates in order to begin to determine whether these properties contribute to species persistence. DESIGN: S. mitis biovar 1 was collected from four infants from birth to the first year of age. At each of eight to nine visits, 60 isolates each were obtained from the cheeks, tongue and incisors (once erupted) yielding 4440 in total. These were tested for production of neuraminidase, beta1-N-acetylglucosaminidase, beta1-N-acetylgalactosaminidase, IgA1 protease and amylase-binding. Antigenic diversity was examined by ELISA and Western immunoblotting using antisera raised against S. mitis biovar 1 NCTC 12261(T) and SK145. RESULTS: Three thousand three hundred and thirty (75%) of the isolates were identified as S. mitis biovar 1 and 3144 (94.4%) could be divided into four large phenotypic groups based on glycosidase production. Fifty-four percent of the isolates produced IgA1 protease, but production was disproportionate among the phenotypes. Between one-third and one-half of the strains of each phenotype bound salivary alpha-amylase. Antisera against strains NCTC 12261(T) and SK145 displayed different patterns of reactivity with randomly selected representatives of the four phenotypes. CONCLUSIONS: S. mitis biovar 1 is physiologically and antigenically diverse, properties which could aid strains in avoiding host immunity and promote re-colonization of a habitat or transfer to a new habitat.

Antigens, Bacterial↗
PubMed2006

A revised Emotional Intelligence Scale: factor re-evaluation and item reduction.

The original Emotional Intelligence Scale of Fukunishi utilized 65 items measuring 3 basic dimensions: intrapersonal, interpersonal, and situational. 170 psychiatric outpatients (84 men and 86 women) completed the inventory. The mean age of the sample was 41.1 yr. (SD= 12.4). Compared with the 65-item scale, factor re-analysis yielded a new 34-item solution with significant correlations for the Intrapsychic (.97) and Interpersonal dimensions (.96) of the larger scale, but not with the Situational dimension (.43). The correlation between the total inventory scores was also significant (.94).

Adult↗
PubMed2005

Late stage (III and IV) non-small cell cancer of the lung: results of surgical resection at Inova Fairfax Hospital.

One hundred forty-two patients underwent surgery and related treatment for advanced stage (III, IV) non-small cell cancer of the lung. One hundred seventeen patients underwent up-front surgery, with a hospital mortality rate of 1.7% (2/117). Kaplan-Meier 5-year survival in this group was 31% (+/- 5). Twenty-five patients underwent neoadjuvant therapy followed by surgical resection, with respective rates of hospital mortality, complete pathologic response, and major pathologic response of 0%, 16%, and 64%. Kaplan-Meier 5-year survival in this latter group was 34% (+/- 11). Of the 16 patients undergoing neoadjuvant therapy who had complete pathologic response or significant downstaging from stage III disease, Kaplan-Meier 5-year survival was 61% (+/- 15). Three clinical observations of interest emerged regarding survival. First, in those patients with postresection FEV1 < 1.0 L, hospital mortality rate was 20%, and there were no 5-year survivors (P < 0.0001). Second, where neoadjuvant therapy was associated with complete pathologic response or significant downstaging of disease, there was a trend for improved survival in the downstaged group, but it did not reach statistical significance (P = 0.14). Third, adjuvant therapy was associated with improved 5-year survival (P = 0.03), particularly for combination chemotherapy and radiotherapy (P = 0.02).

Adult↗
PubMed2005

Clonal diversity and turnover of Streptococcus mitis bv. 1 on shedding and nonshedding oral surfaces of human infants during the first year of life.

Streptococcus mitis bv. 1 is a pioneer colonizer of the human oral cavity. Studies of its population dynamics within parents and their infants and within neonates have shown extensive diversity within and between subjects. We examined the genetic diversity and clonal turnover of S. mitis bv. 1 isolated from the cheeks, tongue, and primary incisors of four infants from birth to 1 year of age. In addition, we compared the clonotypes of S. mitis bv. 1 isolated from their mothers' saliva collected in parallel to determine whether the mother was the origin of the clones colonizing her infant. Of 859 isolates obtained from the infants, 568 were unique clones. Each of the surfaces examined, whether shedding or nonshedding, displayed the same degree of diversity. Among the four infants it was rare to detect the same clone colonizing more than one surface at a given visit. There was little evidence for persistence of clones, but when clones were isolated on multiple visits they were not always found on the same surface. A similar degree of clonal diversity of S. mitis bv. 1 was observed in the mothers' saliva as in their infants' mouths. Clones common to both infant and mothers' saliva were found infrequently suggesting that this is not the origin of the infants' clones. It is unclear whether mucosal immunity exerts the environmental pressure driving the genetic diversity and clonal turnover of S. mitis bv. 1, which may be mechanisms employed by this bacterium to evade immune elimination.

Adult↗
PubMed2004

A pragmatic and successful approach to treating nonsmall-cell lung carcinoma.

Lung cancer is the single leading cause of cancer deaths for men and women combined. Nonsmall-cell lung carcinoma (NSCLC), which results largely from smoking tobacco, accounts for 87% of all lung cancer cases. Methods of patient selection, preoperative and intraoperative care, and postoperative outcomes for patients with NSCLC who were treated from 1991 through 2003 at Inova Fairfax Hospital are discussed. All patients were treated with surgery, some selectively and progressively with a combination of preoperative neoadjuvant therapy, to try to downstage the disease to make complete resection feasible. Outcomes from this data collection period match or exceed the best results for treatment of late-stage (ie, III and IV) disease reported anywhere to date.

Aged↗
PubMed2004

Study of humoral immunity to commensal oral bacteria in human infants demonstrates the presence of secretory immunoglobulin A antibodies reactive with Actinomyces naeslundii genospecies 1 and 2 ribotypes.

The mouths of three human infants were examined from birth to age 2 years to detect colonization of Actinomyces naeslundii genospecies 1 and 2. These bacteria did not colonize until after tooth eruption. The diversity of posteruption isolates was determined by ribotyping. Using immunoblotting and enzyme-linked immunosorbent assay, we determined the reactivity of secretory immunoglobulin A (SIgA) antibodies in saliva samples collected from each infant before and after colonization against cell wall proteins from their own A. naeslundii strains and carbohydrates from standard A. naeslundii genospecies 1 and 2 strains. A. naeslundii genospecies 1 and 2 carbohydrate-reactive SIgA antibodies were not detected in any saliva sample. However, SIgA antibodies reactive with cell wall proteins were present in saliva before these bacteria colonized the mouth. These antibodies could be almost completely removed by absorption with A. odontolyticus, a species known to colonize the human mouth shortly after birth. However, after colonization by A. naeslundii genospecies 1 and 2, specific antibodies were induced that could not be removed by absorption with A. odontolyticus. Cluster analysis of the patterns of reactivity of postcolonization salivary antibodies from each infant with antigens from their own strains showed that not only could these antibodies discriminate among strains but antibodies in saliva samples collected at different times showed different reactivity patterns. Overall, these data suggest that, although much of the salivary SIgA antibodies reactive with A. naeslundii genospecies 1 and 2 are directed against genus-specific or more broadly cross-reactive antigens, species, genospecies, and possibly strain-specific antibodies are induced in response to colonization.

Actinomyces↗
PubMed2004

Attribution of cause by patients with depression, anxiety, and alexithymia.

This study evaluated the relationship between the personality construct of alexithymia and the attribution of depression to biological, psychological, sociocultural, and external stress. When alexithymia was considered as a continuous variable, there was a significant correlation between a higher score on the Toronto Alexithymia Scale and a greater belief in psychological causes for their psychiatric disorder. The other factors also had positive but nonsignificant correlations with alexithymia. When alexithymia was categorically partitioned and controlled for depressed mood, alexithymic subjects more frequently endorsed all four factors to be causal for their psychiatric illness. This appears to contradict earlier assumptions that alexithymic patients tend to be less psychologically minded than those without this psychological trait.

Adult↗
PubMed2003

Urine testing for drugs of abuse: a survey of suburban parent-adolescent dyads.

BACKGROUND: The American Academy of Pediatrics is opposed to involuntary diagnostic testing for drugs of abuse. OBJECTIVE: To gather data about attitudes of parents and their teenagers about involuntary drug testing on parental request. DESIGN: Adolescents and their accompanying parents separately answered a printed survey in the offices of their private pediatrician. The survey posed 2 hypothetical questions about urine testing: (1) Do parents have the right to ask a teenager's physician to order a urine test for drugs of abuse without the teenager's knowledge-if the teenager has falling school grades, an uncooperative attitude, and major untruthfulness? (2) In such a case, should the teenager's physician obtain a urine test for drugs on parental request only, without the teenager's consent? RESULTS: A total of 393 paired evaluable surveys were collected: 77.6% from Virginia and 22.4% from Ohio. There were no significant differences in answers between the 2 study sites. Of the students, 85.8% had either an A or a B grade point average. Current marijuana use was unusually low in our teenaged respondents. Of the parents surveyed, 81.7% would want a physician to be able to perform a urine test for drugs of abuse for a problematic teenager without the young person's consent. The answers to the 2 questions about urine drug tests had poor kappa coefficients of agreement between teenagers and parents (0.04 and 0.09, respectively). Reanalysis, using the variables of age, grade point average, and frequency of marijuana smoking, showed little difference in agreement scores. CONCLUSIONS: In the 2 suburban pediatric practices surveyed, parental opinions and expectations were at variance with the American Academy of Pediatrics policy statement on nonconsensual urine drug testing in the presence of clinical problems. Pediatricians need to be conscious of this clinical-ethical dilemma, become familiar with the American Academy of Pediatrics policy on drug testing, and develop their own position and expertise in this area. The dyad method (parent-teenager survey) is novel and improved the methodology of our study. We surveyed middle-class suburban adolescents while previous studies of adolescents surveyed inner-city populations.

Adolescent↗
PubMed2003

Thoracic esophageal perforations.

BACKGROUND: Recognition of the importance of early diagnosis and aggressive, definitive surgical intervention has brought about a dramatic decline in mortality related to distal esophageal perforation. METHODS: We retrospectively analyzed all cases of thoracic esophageal perforation diagnosed at our hospital from September 1, 1979, through April 1, 2001. The study group consisted of 62 patients (43 men) with a mean age of 58.8 years (range, 20-92 yr). RESULTS: In the group of 39 patients with early diagnosis (< or = 24 h), hospital survival was 87%, which increased to 93% when early diagnosis was combined with aggressive surgical treatment Among the 23 patients with late diagnosis (> 24 h), survival approached 70%. Yet, in patients who were treated aggressively with surgery, survival was almost 90% despite delayed diagnosis. CONCLUSION: We recommend aggressive, definitive surgery for thoracic esophageal perforations, whether diagnosed early or late. A variety of options are discussed with regard to complicated presentations.

Adult↗
PubMed2003

Multimodality treatment for esophageal cancer: the role of surgery and neoadjuvant therapy.

Treatment of esophageal cancer has traditionally included surgery as the initial modality. Neoadjuvant chemoradiation therapy has been introduced with the goal of downstaging tumors before surgical resection; however, its role in esophageal cancer remains controversial. We report 116 patients who underwent esophagogastrectomy with reconstruction for carcinoma of the esophagus or esophagogastric junction over a 10-year period (January 1, 1990 to June 1, 2001). Forty patients underwent neoadjuvant radiation and chemotherapy followed by surgery. Hospital mortality in this group was 7.5 per cent, complete pathologic response (CPR) was 37.5 per cent, and overall 3- and 5-year survival rates were 47 and 38 per cent. Five-year survival in the 15 patients with CPR was 85 per cent. Five patients underwent neoadjuvant single-agent therapy (four chemotherapy and one radiation) followed by surgery, and none survived to 3 years. Seventy-one patients underwent surgery without neoadjuvant therapy. Hospital mortality in this group was 1.4 per cent, with 3- and 5-year survival of 21 and 17 per cent--a decreased long-term survival compared with the neoadjuvant therapy group despite the observation that patients who underwent neoadjuvant therapy had a larger tumor size on presentation (5.5 +/- 0.4 cm vs 3.8 +/- 0.2 cm; P = 0.002). Squamous cell carcinomas seemed to be more responsive to neoadjuvant radiation and chemotherapy followed by surgery than were adenocarcinomas, with a CPR of 44.4 versus 35.5 per cent; however, 5-year survival rates in these complete responders were not significantly different (100% and 78%, respectively; P = 0.97). We report that esophagogastrectomy in conjunction with neoadjuvant therapy results in increased survival compared with surgery without neoadjuvant therapy (P < 0.01), although there may be an increased perioperative mortality associated with neoadjuvant therapy. Further studies are needed to evaluate the role of preoperative chemoradiation and to better identify the pretreatment characteristics of patients with a complete pathological response.

Adenocarcinoma↗
PubMed2002

The role of endorectal coil MRI in patient selection and treatment planning for prostate seed implants.

PURPOSE: To assess the role of endorectal coil magnetic resonance imaging (MRI) staging for patients undergoing seed implantation (SI) with or without external beam radiotherapy (EBRT). MATERIALS AND METHODS: Between October 1994 and December 1998, 390 patients underwent prostate SI (98% Pd-103, 2% I-125). Seventy-six percent of patients had a prostate serum antigen (PSA) < 10, 17% had PSA of 10-20, and 7% of patients had PSA of > 20. Ten percent of patients had a Gleason score (GS) of 4-5, 54% had GS 6, 29% had GS 7, and 7% had GS >/= 8. Monotherapy was employed in 46% of patients, and the remaining 54% received combined EBRT and SI. Three hundred twenty-seven were staged by high-resolution phased array pelvic coil, or in most cases, an endorectal coil MRI. The MRI findings were used to guide stage-appropriate treatment recommendations, and to assist in the preplanning and optimization of seed distributions. The criteria utilized to determine MRI-based stage were founded on the reported literature from the University of Pennsylvania. All MRI studies were reviewed by C.A., D.B., or W.H., who were unaware of clinical stage at the time of their review. The biopsy report was available to them as the only clinical correlate. RESULTS: Of the 327 patients staged by MRI, 70% were upstaged from the digital rectal examination-based clinical stage; 26% of T(1), T(2) patients were upstaged to T(3). Perineural invasion and the percentage of positive cores predicted for T(3) MRI stage (p < 0.0001 for both variables). MRI findings changed the overall treatment recommendation in 60/327 (18%) patients. The majority of these patients were advised to receive combined therapy instead of monotherapy after the MRI documented more extensive disease. The seed distribution was modified in 183/327 (56%) patients, mostly related to preplanned extracapsular coverage of bulky or extraprostatic disease seen on MRI. With a mean follow-up of 38 months (range 3-72), PSA freedom from progression (FFP) was 94% at 5 years. Cox regression analysis showed that only the percentage of positive cores (p = 0.001) and failure to have MRI staging (p = 0.0008) predicted for failure. Pretreatment PSA level, Gleason score, perineural invasion, and external beam radiotherapy did not significantly predict for PSA failure. We compared our MRI T(3) intermediate-risk group patients treated by combined therapy with a previous study of T(3) intermediate-risk group treated by radical prostatectomy (RP) at the University of Pennsylvania. Our 36-month PSA FFP was 94% compared with 21% for the previous study's RP patients. CONCLUSION: MRI is a valuable staging procedure for prostate cancer patients treated by SI. PSA FFP results appear to be improved by MRI staging. MRI T(3) disease can be treated more effectively by SI + EBRT than by RP.

Brachytherapy↗
PubMed2002

Antibiotic use for upper respiratory tract infections: how well do pediatric residents do?

BACKGROUND: Antibiotics are often used inappropriately for the treatment of upper respiratory tract infections in children, and the emergence of resistant bacteria is a growing public health concern. OBJECTIVE: To assess awareness and compliance with the Centers for Disease Control and Prevention (Atlanta, Ga) and American Academy of Pediatrics (Elk Grove Village, Ill) principles for judicious antibiotic use for upper respiratory tract infections among residents from a sample of pediatric residency programs in the mid-Atlantic region of the United States. PARTICIPANTS AND METHODS: Residents at the participating programs were requested to complete a survey questionnaire. RESULTS: Of the 524 pediatric residents surveyed, 74% (388 participants) completed the questionnaire. Familiarity with the principles increased with a year of training; 16%, 36%, and 50% of first-year (PL1), second-year (PL2), and third- or fourth-year (PL3/PL4) residents, respectively, had heard or read about the principles (chi(2)(trend); P<.001). In response to a direct question about the use of antibiotics for an otherwise well, afebrile 18-month-old child with purulent rhinorrhea, 29%, 25%, and 15% of PL1, PL2, and PL3/PL4 residents, respectively, would prescribe antibiotics within 10 days of onset of illness (chi(2)(trend); P =.008). A significant difference was found between PL1 vs PL3/PL4 participants (difference = 20%; 95% CI = 3%-26%). If the same infant had a temperature of 38.8 degrees C, then 63%, 45%, and 47% of PL1, PL2, and PL3/PL4 residents, respectively, would prescribe antibiotics (chi(2)(trend); P =.008). CONCLUSIONS: Awareness among pediatric residents about the judicious use of antibiotics for upper respiratory tract infections is often lacking, and inappropriate use of antibiotics for this condition continues to be prevalent. This was especially noted among PL1 residents, with an improving trend noted with increasing years of training.

Data Collection↗
PubMed2002

The impact of liver disease on health-related quality of life: a review of the literature.

Quality of life as an outcome variable has become an important measure in clinical research. Making a transition from a "biomedical model" of health to one that incorporates the social aspects of disease, clinicians and researchers dealing with chronic illness now incorporate quality-of-life measures into clinical practice and research. Chronic liver disease has shown a significant impact on the well-being of patients and contributes to the significant morbidity associated with these conditions. In this article, we review the recent research that has examined the impact of chronic liver disease on health-related quality of life.

Chronic Disease↗
PubMed2002

The utility of radiological imaging in nonalcoholic fatty liver disease.

BACKGROUND & AIMS: This prospective study evaluates the role of radiological modalities in establishing the diagnosis of nonalcoholic steatohepatitis (NASH). METHODS: Consecutive patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) were enrolled (2000-2001). Patients with other liver diseases and significant alcohol consumption (>20 g/day) were excluded. Clinicodemographic data were gathered at the time of liver biopsy. Each biopsy specimen was assessed by a hepatopathologist. Each patient underwent a limited abdominal ultrasonography (US), computerized tomography (CT), and magnetic resonance imaging (MRI). Films were interpreted by a radiologist who used a predetermined radiological protocol. Each radiological study was reread by the same radiologist and a second radiologist. RESULTS: Patients with NASH had greater aspartate aminotransferase levels (P = 0.03), greater ferritin levels (P = 0.05), more hepatocyte ballooning (P < 0.0001), and more fibrosis (P = 0.002). None of the radiological features distinguished between NASH and other types of NAFLD. No radiological modality detected the presence of hepatocyte ballooning, Mallory's hyaline, or fibrosis, which are important features in the diagnosis of NASH. The presence of >33% fat on liver biopsy was optimal for detecting steatosis on radiological imaging. CONCLUSIONS: Differences between NASH and nonprogressive NAFLD were not apparent with any radiological modality. Of the pathologic features important for establishing the diagnosis of NASH, only the severity of steatosis was reflected in these radiological modalities. Good intraobserver agreement was evident for each modality (US, CT, and MRI) that was superior to interobserver agreement.

Adult↗
PubMed2002

Are pediatricians adhering to principles of judicious antibiotic use for upper respiratory tract infections?

BACKGROUND: In 1997, the Centers for Disease Control and Prevention (CDC), in collaboration with other professional organizations, released principles for judicious use of antibiotics in pediatric upper respiratory illnesses (URI). This study compared use of antibiotics for URI in children before (1995) and after (1998) publication of the principles and compared survey responses with practice habits. METHODS: A questionnaire was mailed to a sample of pediatricians in northern Virginia. Office records of a randomly selected subset of pediatricians were reviewed. RESULTS: Seventy-five percent of pediatricians completed the questionnaire; 51/149 (34%) chose to prescribe antibiotics for purulent rhinorrhea of less than 10 days' duration. This was significantly lower than that reported in the 1995 survey. However, review of office records of a random sample of these pediatricians revealed no significant difference in antibiotic use in children with uncomplicated URI in the 2 years studied. CONCLUSIONS: Injudicious antibiotic use for URI is prevalent among pediatricians in northern Virginia. Actual practice habits are at variance with response to case vignettes.

Anti-Bacterial Agents↗
PubMed2002

Mediastinal staging of non-small cell lung carcinoma using computed and positron-emission tomography.

BACKGROUND: We evaluated the accuracy of computed tomography (CT) and positron-emission tomography (PET) in the mediastinal staging of non-small cell lung cancer. METHODS: Between May 14, 1999, and November 28, 2000, computerized tomography (CT) and positron-emission tomography (PET) were used to clinically stage 94 consecutive patients with non-small cell carcinoma of the lung (NSCCL). All patients underwent subsequent surgical staging with mediastinoscopy, anterior mediastinotomy, and/or thoracotomy with mediastinal lymphadenectomy. RESULTS: Overall accuracy was the same for both procedures. False-negative results occurred 3 times more often with CT; false-positive results occurred twice as often with PET. Sensitivity and specificity were 64% and 94%, respectively, for CT, versus 88% and 86%, respectively, for PET. Positive and negative predictive values were 80% and 88%, respectively, for CT, versus 71% and 95%, respectively, for PET. CONCLUSION: In addition to routine use of CT, PET seems to achieve high negative predictive value in the evaluation of mediastinal disease; PET seems particularly helpful in assessing absence of tumor in bulky nodes after neoadjuvant chemotherapy and/or radiotherapy.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Medical marijuana: a survey of teenagers and their parents.

Parents and their teenage children were questioned about medical marijuana and whether they believed that passage of medical marijuana laws in their states would increase teenage use of marijuana for non-medical purposes. A 24-question written survey was distributed separately to teenager/parent pairs who visited 1 of 2 suburban general pediatric offices located in Vienna, Virginia or Mason, Ohio. Completed surveys were collected from 393 parent-teen pairs. Only 13% of the teenagers admitted to ever smoking marijuana while 6% admitted smoking it in the past 30 days. There was good agreement between parents and teens (81% of parents and 76% of their teenagers who responded to the survey) that regular use of marijuana causes harm to many or most users, not just "potheads." Although there was close agreement in the range of opinions about medical marijuana (i.e., from liberal use to no use) by parents as a group and the teens as a group, agreement between the answers of parents matched with their own children was poor based on K-coefficient analysis (K = 0.20). Twenty-eight percent of the parent group and 55% of the teenagers believed that passage of state laws for medical marijuana would make it easier for teens to smoke marijuana for medical purposes.

Adolescent↗