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Biomedical subjects

P Cole

Publications and source records attributed to P Cole.

At least 19 recordsLinked to original sources
PubMed2006

Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure?

BACKGROUND: Adhesions can result in serious clinical complications and make ileostomy closure, which is relatively simple procedure into a complicated and prolonged one. The use of sodium hyaluronate and carboxymethyl cellulose membrane (Seprafilm) was proven to significantly reduce the postoperative adhesions at the site of application. The aim of this study was to assess the incidence and severity of adhesions around a loop ileostomy and to analyze the length of time and morbidity for mobilization at the time of ileostomy closure with and without the use of Seprafilm. METHODS: Twenty-nine surgeons from 15 institutions participated in this multicenter prospective randomized study. 191 patients with loop ileostomy construction were randomly assigned to either receive Seprafilm under the midline incision and around the stoma (Group I), only under the midline incision (Group II), or not to receive Seprafilm (Group III). At ileostomy closure, adhesions were quantified and graded; operative morbidity was also measured. RESULTS: All 3 groups were comparable relative to gender, mean age and number of patients with prior operations (26, 25 and 19, respectively). Group II patients were significantly more likely to have pre-existing adhesions than Group III patients (30.6% vs. 14.1%, p = 0.025). At stoma mobilization, significantly more patients in Group III than in Group I had adhesions around the stoma (95.2% vs. 82.3%, p = 0.021). Mean operative times were 27, 25, and 28 minutes, respectively (p = 0.38), with significant differences among sites. There was no significant difference in the number of patients needing myotomy or enterotomy (29, 27 and 24 patients, respectively), nor in the number of postoperative complications (7, 9 and 7 patients, respectively). CONCLUSIONS: When consistently applied, Seprafilm significantly decreased adhesion formation around the stoma but not operative times without any increase in the need for myotomy or enterotomy. These findings were not seen in the overall study population possibly due to the large number of surgeons using a variety of application techniques.

Adjuvants, Immunologic↗
PubMed2006

The Jehovah's Witness and dementia: who or what defines 'best interests'?

An elderly woman with dementia presented for repeat surgical management of fractured neck of femur. Although no advance directive had ever been generated, the patient was declared to be a strict Jehovah's Witness by her daughter, who vetoed the transfusion of any blood products. The fracture was managed conservatively but the patient suffered repeated chest infections, from which she died 4 months after admission. This case raised several clinical, ethical and legal issues and generated a spectrum of opinion as to the appropriateness of operative intervention, transfusion and provision of intensive care. We suggest that professional guidelines and the new Mental Capacity Act 2005 do not provide explicit and comprehensive guidance for practitioners. Further deliberation is required to bring about convergence between the law, ethical principles and professional guidelines.

Aged, 80 and over↗
PubMed2006

IFN gamma and CXCR-1 gene polymorphisms in idiopathic bronchiectasis.

Idiopathic bronchiectasis is a disease of chronic, bacterial lung infection, unresolving inflammation and progressive lung damage. Bronchiectasis can be associated with autoimmune diseases including ulcerative colitis. Defects of both innate and adaptive immunity have been proposed. The airway inflammation is characterized by interleukin-8 (IL-8) expression and infiltration by neutrophils and T cells. Here we investigated two candidate gene polymorphisms that may contribute to disease susceptibility: a CXCR-1 (+2607 G/C) gene polymorphism that is implicated in IL-8 binding and neutrophil trafficking as well as the interferon-gamma (IFNgamma) (+874 T/A) polymorphism which is linked to levels of IFNgamma production. These polymorphisms were distributed similarly in the idiopathic bronchiectasis group and controls, suggesting that these two candidate gene polymorphisms are not associated with disease susceptibility.

Alleles↗
PubMed2005

Tobacco use among Swedish schoolchildren.

OBJECTIVE: To study the prevalence of snus use and of smoking among Swedish schoolchildren from 1989 to 2003. DESIGN: Surveys conducted by the Swedish Council for Information on Alcohol and Other Drugs. SETTING: All of Sweden. SUBJECTS: 84,472 boys and girls age 15-16 years. MAIN OUTCOME MEASURES: Subjects are classified as non-smokers, occasional smokers, and regular smokers, and into three similar categories for snus use. Tobacco use is reported as sex specific prevalence. RESULTS: During the period 1989 to 2003, the prevalence of tobacco use declined both among boys and girls. For boys, regular smoking declined after 1992 from 10% to 4%. Their snus use was about 10% in the 1990s but increased to 13% by 2003. Regular smoking among girls was 20% in early years and declined to 15%. Smoking among girls was always double that among boys. Patterns of occasional tobacco use were similar to those of regular use. CONCLUSIONS: The high prevalence of snus use in Sweden not only reduces smoking rates among Swedish men, but suppresses smoking among boys as well.

Adolescent↗
PubMed2004

The influence of smoking and smokeless tobacco use on weight amongst men.

OBJECTIVE: To explore the effect of tobacco use (smoking and smokeless tobacco) and cessation on body weight. DESIGN: Cross-sectional and prospective follow-up study. SETTING: Northern Sweden. SUBJECTS: A total of 2993 men aged 25-64 years who participated in the northern Sweden MONICA study in 1986, 1990 or 1994, 1650 of whom were followed up in 1999. MAIN OUTCOME MEASURES: The prevalence of overweight [body mass index (BMI) >/= 27] amongst tobacco users was compared with nonusers at entry into the study. The average annual percentage weight gain amongst men was also determined according to tobacco use both at entry and at follow-up, and the development of overweight amongst tobacco-use groups was reported using standardized incidence ratios. RESULTS: Smokers who quit tobacco during the follow-up period gained significantly more weight than smokers who switched to snus (annual gain 0.96% vs. 0.51%, P < 0.05). At entry, ex-smokers had higher prevalence of overweight than nonusers of tobacco [prevalence ratio (PR) = 1.24, 95% confidence interval (CI) = 1.10-1.40]. Snus users had slightly higher prevalence of overweight at entry (PR = 1.20, CI = 1.01-1.42). Snus users who quit gained more weight than nonusers (0.70% vs. 0.44%, P < 0.05) or those who continued to use snus (0.42%). CONCLUSIONS: Cessation of tobacco, either cigarettes or snus, leads to significantly increased weight gain. However, snus use may play a role in lowering the weight gain following smoking cessation.

Adult↗
PubMed2003

18FDG-Positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Glivec).

Imatinib mesylate (Glivec, formerly STI571) is the first effective systemic treatment for gastrointestinal stromal tumours (GISTs). Major changes in tumour volume, however, tend to occur late after the start of treatment. The aim of this study was to evaluate if [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) can be used for the early evaluation of response to imatinib mesylate treatment in soft-tissue sarcomas (STS). 21 patients (17 GIST, 4 other STS) underwent FDG-PET imaging prior to and 8 days after the start of treatment. PET response (European Organization for Research and Treatment (EORTC) guidelines) was observed in 13 GISTs (11 Complete Responders, 2 partial responders. Subsequent computerised tomography (CT) response Response Evaluation Criteria in Solid Tumours (RECIST) was observed in 10 of these patients after a median follow up of 8 weeks. Stable or progressive disease was observed on PET in 8 patients and none of them achieved a response on CT. PET response was also associated with a longer progression-free survival (PFS) (92% versus 12% at 1 year, P=0.00107). We conclude that FDG-PET is an early and sensitive method to evaluate an early response to imatinib treatment.

Adult↗
PubMed2003

Evolving patterns of tobacco use in northern Sweden.

BACKGROUND AND OBJECTIVES: Cross-sectional data from northern Sweden suggest that the increased use of Swedish moist snuff (snus) may have contributed to a decline in the prevalence of smoking, especially amongst men. This study describes the evolving patterns of tobacco use in this population over the period 1986-1999. DESIGN: This is a prospective follow-up study of 1651 men and 1756 women, aged 25-64 years, who were enrolled in the northern Sweden MONICA project (entry in 1986, 1990, 1994) and who were followed-up in 1999. Information on tobacco use at entry and at follow-up was used to describe the stability of tobacco use over a period of 5-13 years ending in 1999. RESULTS: Snus was the most stable form of tobacco use amongst men (75%); only 2% of users switched to cigarettes and 20% quit tobacco altogether. Smoking was less stable (54%); 27% of smokers were tobacco-free and 12% used snus at follow-up. Combined use (smoking and snus) was the least stable (39%), as 43% switched to snus and 6% switched to cigarettes. Former users of both products were much less stable than former users of either cigarettes or snus. The stability of smoking amongst women was 69%, which was higher than that amongst men (P < 0.05). CONCLUSIONS: The use of snus played a major role in the decline of smoking rates amongst men in northern Sweden. The evolution from smoking to snus use occurred in the absence of a specific public health policy encouraging such a transition and probably resulted from historical and societal influences.

Adult↗
PubMed2002

Sudden infant death syndrome risk factors in north Queensland: a survey of infant-care practices in Indigenous and non-Indigenous women.

OBJECTIVE: To assess the prevalence of sudden infant death syndrome (SIDS) risk factors in the Indigenous and non-Indigenous community of Townsville, a large remote urban centre in north Queensland, Australia. METHODS: Thirty Indigenous and 30 non-Indigenous women with young children were surveyed using sections of the West Australian Infancy and Pregnancy Survey 1997-1998. The prevalence of SIDS risk factors was compared between the two groups and medians and univariate associations were generated where appropriate. RESULTS: The Indigenous women were significantly younger and more likely to be single. The median age of the infants was 8 months (range 0.3-26 months) with no difference between the two groups. Thirty-seven per cent of Indigenous infants slept prone (cf. 17% of non-Indigenous infants; P = 0.03), and 77% shared a bed (cf. 13% of non-Indigenous infants; P < 0.001). The Indigenous households had significantly more members, with 57% including extended family members (cf. 20% non-Indigenous group; P = 0.003). Fifty-three per cent of the Indigenous women smoked during pregnancy (cf. 23% of non-Indigenous women; P = 0.017), 60% were smokers at the time of the interview, and smoking occurred inside 40% of Indigenous houses (cf. 20% and 20% for non-Indigenous women, respectively; P < 0.001, 0.09). CONCLUSION: This small survey suggests that the prevalence of SIDS risk factors is higher in the Indigenous population, and a new approach to education is needed urgently to promote SIDS awareness among Indigenous women.

Adolescent↗
PubMed2002

The effects of pneumolysin and hydrogen peroxide, alone and in combination, on human ciliated epithelium in vitro.

We have investigated the effects of pneumolysin and H2O2, putative virulence factors of Streptococcus pneumoniae, on the ciliary beat frequency and structural integrity of human ciliated epithelium in vitro. Human ciliated epithelium was obtained by brushing the inferior nasal turbinate of healthy human volunteers. Ciliary slowing (CS) was measured using a photo-transistor technique and epithelial damage (ED) was documented using a visual scoring index. Effects of recombinant pneumolysin (100 ng/ml), a mutant pneumolysin preparation with markedly reduced haemolytic activity (100 ng/ml) and reagent H2O2 (100 microM) were measured alone and in combination, in the absence and presence of catalase (1000 units/ml). When used individually, both recombinant pneumolysin and H2O2 caused significant (P < 0.05) CS and ED. The effects of H2O2 but not those of pneumolysin were almost completely attenuated by catalase, while the mutant pneumolysin preparation did not cause significant CS or ED. When used in combination, the effects of pneumolysin and H2O2 on CS and ED were additive as opposed to synergistic. These actions of pneumolysin and H2O2 may contribute to the pathogenesis of respiratory tract infections caused by the pneumococcus.

Bacterial Proteins↗
PubMed2001

CBP/p300 and muscle differentiation: no HAT, no muscle.

Terminal differentiation of muscle cells follows a precisely orchestrated program of transcriptional regulatory events at the promoters of both muscle-specific and ubiquitous genes. Two distinct families of transcriptional co-activators, GCN5/PCAF and CREB-binding protein (CBP)/p300, are crucial to this process. While both possess histone acetyl-transferase (HAT) activity, previous studies have failed to identify a requirement for CBP/p300 HAT function in myogenic differentiation. We have addressed this issue directly using a chemical inhibitor of CBP/p300 in addition to a negative transdominant mutant. Our results clearly demonstrate that CBP/p300 HAT activity is critical for myogenic terminal differentiation. Furthermore, this requirement is restricted to a subset of events in the differentiation program: cell fusion and specific gene expression. These data help to define the requirements for enzymatic function of distinct coactivators at different stages of the muscle cell differentiation program.

Acetyltransferases↗
PubMed2001

The fifty-year decline of cancer in America.

PURPOSE: From 1950 to 1990, the overall cancer mortality rate increased steadily in the United States, a trend which ran counter to declining mortality from other major diseases. The purpose of this study was to assess the impact of lung cancer on all-cancer mortality over the past 50 years. METHODS: Data from the National Centers for Health Statistics were used to develop mortality rates for all forms of cancer combined, lung cancer, and other-cancer (all-cancer minus lung cancer) from 1950 to 1998. RESULTS: When lung cancer is excluded, mortality from all other forms of cancer combined declined continuously from 1950 to 1998, dropping 25% during this period. The decline in other-cancer mortality was approximately 0.4% annually from 1950 to 1990 but accelerated to 0.9% per year from 1990 to 1996 and to 2.2% per year from 1996 to 1998. CONCLUSION: The long-term decline is likely due primarily to improvements in medical care, including screening, diagnosis, and treatment.

Humans↗
PubMed2001

An examination of the psychometric structure of the Multidimensional Pain Inventory.

Factor analyses to create the Multidimensional Pain Inventory (MPI) warrant further examination due to small sample size, the use of separate factor analyses for each MPI section, and lack of evidence for the replicability of the factor model. The present study randomly assigned 972 respondents to one of three samples. Study 1 used data from Sample 1 (n = 452) to examine the replicability of the MPI factor structure reported by Kerns, Turk, and Rudy (1985), and to measure the internal consistencies of MPI scales. In Study 2, confirmatory factor analyses using Sample 2 data (n = 267) verified a revised MPI factor structure that was generated in Study 1; cross-validation was achieved using data from Sample 3 (n = 253). The revised MPI model differed from the original model in its number of scales and pattern of scale loadings. Recommendations for the refinement of the MPI are proposed.

Adult↗
PubMed2001

Cavitary lung disease.

A 20-year-old female Ethiopian refugee presented with a 6-month history of cough and progressive left shoulder tip pain. After extensive investigation, which failed to demonstrate a cause, she proceeded to thoracotomy, where a 25-cm length of tubing was found that had perforated the left hemidiaphragm and had extended into the apex of the left lung. This appeared to have arisen as a complication of a termination of pregnancy performed years previously. This represents the first reported case of significant pulmonary trauma arising as a complication of a termination of pregnancy.

Abortion, Induced↗
PubMed2001

Upper airway pressures in snorers and nonsnorers during wakefulness and sleep.

OBJECTIVE: To compare upper airway pressures in snorers and nonsnorers during sleep and wakefulness. DESIGN: Case series of snorers and nonsnoring controls. SETTING: Sleep clinic of a university hospital. METHODS: We used open catheters to measure differential nasopharyngeal and hypopharyngeal pressures in 8 nonapneic snorers with excessive daytime tiredness and 10 healthy nonsnoring controls. Measurements were performed during sleep (with the mouth taped to ensure exclusively nasal breathing) and wakefulness. When awake, the subjects were either seated (with the head neutral, flexed, extended, or rotated) or recumbent (dorsal and lateral positions). MAIN OUTCOME MEASURES: Comparison of pressures within the group as a function of body position and between the groups as a function of snoring. RESULTS: Differential nasal and pharyngeal pressures were similar in seated snorers and nonsnorers independently of head position. Assumption of recumbency resulted in significantly increased pharyngeal pressures in nonsnorers (26 +/- 18 Pa seated vs. 52 +/- 46 Pa recumbent, p < .05) and snorers (50 +/- 35 Pa seated vs. 93 +/- 38 recumbent, p < .01). The increase was higher in snorers than nonsnorers. During snoring, sleep differential pharyngeal pressures in snorers were markedly increased compared to quiet sleep (567 +/- 450 Pa during snoring epochs vs. 117 +/- 82 Pa during nonsnoring epochs, p < .01). CONCLUSIONS: Compared to nonsnorers, recumbent nonapneic snorers have elevated differential pharyngeal pressures indicative of increased upper airway resistance and reduced airway patency; this is present during wakefulness and sleep.

Adult↗
PubMed2001

Pathophysiology and treatment of airway mucociliary clearance. A moving tale.

Airway hygiene depends largely on mucociliary clearance (MCC) which in turn depends upon the movement of viscoelastic mucus along the airway by the beating of the ciliary appendages of airway epithelial cells. Failure to keep the airways sterile by MCC results in a host inflammatory response to the persistent microorganisms which, if it becomes chronic, causes damage to the airway wall and upregulation of mucus production manifest clinically as bronchiectasis, sinusitis and otitis. There are three principal disorders of MCC. Firstly, primary ciliary dyskinesia (PCD), a rare genetic deficiency of the ultrastructural apparatus required to propel the cilium, in which nasal nitric oxide is very low due to a deficiency of inducible nitric oxide synthase. Secondly, secondary ciliary dyskinesia due principally to microbial toxin-induced dysfunction of the energy pathways required for ciliary beating. Thirdly, abnormalities in the physicochemical properties of mucus, including reduced salt content/osmolality which results in it being unsuitable in quality for cilia to move it. Methods of rectifying this defect promise to restore MCC to normal and interfere in the vicious circle of inflammatory lung damage.

Bronchiectasis↗
PubMed2000

Normative data for the F(p) scale of the MMPI-2: implications for clinical and forensic assessment of malingering.

Data from several clinical samples and the Minnesota Multiphasic Personality Inventory--2 standardization group are presented to familiarize the reader with response patterns of different groups on a new validity scale designed to assist in the identification of exaggeration or fabrication of psychological disturbance. Sensitivity-specificity analyses are included along with suggestions for use of the F(p) Scale with other validity scales. Cautions about setting single cutoff scores are also discussed.

Female↗