The Healthcare Design Research Alliance.
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Color↗
Biomedical subjects
P Pearce
Publications and source records attributed to P Pearce.
Shigella isolates in stool.
A total of 447 Shigella strains were isolated from stool samples during 1989-1991. Of these 270 (60%) were from children. Among the different species and serotypes Sh. flexneri 60 (13.4%) and Sh. sonnei Phage 139 (65%) were the most frequently isolated strains. 154 (34.4%) strains were resistant to three and 179 (40%) to more than three antibiotics. Some strains of Shigella were found to be resistant to furazolidine and neomycin.
Adult↗
Present status of the ovine gene map (Ovis aries); comparison with the bovine map (Bos taurus).
The status of the sheep map to the end of June 1993 is presented. Mapping information is available for a total of 107 loci comprising 16 anonymous DNA segments. This is an increase of 66 loci since 1990. No loci have been mapped on 10 of the 26 autosomes. Comparison of the cattle (350 loci) and sheep maps confirms their close evolutionary and genetic relationship and will reduce the effort required for their gene mapping.
Animals↗
Steroid receptor binding and messenger RNA expression in fibroids from untreated and gonadotrophin-releasing hormone agonist pretreated women.
OBJECTIVE: The hypothesis of this study was that oestrogen may play a role in fibroid growth and that a lack of oestrogen may be the reason for gonadotrophin-releasing hormone agonist (GnRHa) induced fibroid shrinkage. Therefore our aims were (1) to investigate oestrogen receptor (ER) and progesterone receptor (PR) binding in fibroids and myometrium from untreated women and in fibroids from GnRHa pretreated women, (2) to evaluate the mRNA expression of ER and PR in these tissues, and (3) to examine whether a correlation existed between receptor binding and mRNA expression for ER and PR. DESIGN: Cytosolic ER and PR binding was assessed by the dextran-coated charcoal technique and ER and PR mRNA expression was assessed using Northern blots of total RNA. PATIENTS: Fibroid and corresponding myometrial specimens were obtained from 20 women undergoing hysterectomy while fibroid specimens only were obtained from 10 women undergoing myomectomy after at least 3 months pretreatment with GnRHa. RESULTS: We found that (1) ER binding was twice and PR binding was three times as great in fibroid as in myometrium and that there was no difference in binding for either receptor between fibroids from untreated and GnRHa pretreated women, (2) ER and PR mRNA abundances were similar in fibroids and myometrium from untreated women and in fibroids from untreated and GnRHa pretreated women, and (3) ER binding and ER mRNA abundance in both groups of fibroids and myometrium were independent of each other, but there was a positive correlation between PR binding and PR mRNA abundance in untreated fibroids and myometrium but not in GnRHa pretreated tumours. CONCLUSIONS: We conclude that (1) both oestrogen and progesterone may contribute to fibroid growth because of increased receptor binding in fibroids compared with myometrium and (2) in GnRHa treated women, fibroids may shrink because of a lowered circulating oestradiol level rather than because of a change in steroid receptor binding.
Adult↗
Wound infection in total joint arthroplasty: effect of extended wound surveillance on wound infection rates.
OBJECTIVE: To determine the effects of a wound monitoring program on infection rates after total joint arthroplasty. DESIGN: Case series, comparing postoperative wound infection rates before and after hospital discharge. SETTING: A university-affiliated tertiary-care hospital. PATIENTS: A group of 865 patients who underwent primary or revision total hip or knee arthroplasty between September 1989 and September 1991 followed by in-hospital and post-discharge wound monitoring was compared with a baseline group of 204 patients who had undergone an arthroplasty procedure and in-hospital wound monitoring between March and September 1988; only 38 of these patients were selected for post-discharge monitoring. INTERVENTIONS: In the study group, wounds were monitored every 48 to 72 hours to the time of patient discharge and at 30 days post-discharge. Monthly reports of surgeon-specific and overall infection rates were sent to each surgeon during both baseline and study periods. MAIN OUTCOME MEASURES: Presence or absence of surgical wound infection. RESULTS: The initial overall wound infection rate was 9.9%. This decreased to 3.8% in the study group, after the wound monitoring program had been in place for at least 18 months. Post-discharge monitoring accounted for the majority of wound infections diagnosed. CONCLUSIONS: A wound monitoring program may be an important tool in lowering wound infection rates associated with total joint arthroplasty. Post-discharge monitoring is important in determining true wound infection rates.
Alberta↗
Acute mountain sickness in a general tourist population at moderate altitudes.
OBJECTIVE: To determine the incidence of acute mountain sickness in a general population of visitors to moderate elevations, the characteristics associated with it, and its effect on physical activity. DESIGN: A cross-sectional study. SETTING: Resort communities located at 6300 to 9700 feet elevation in the Rocky Mountains of Colorado. PARTICIPANTS: Convenience sample of 3158 adult travelers, 16 to 87 years old (mean age [+/- SD], 43.8 +/- 11.8 years). RESULTS: Twenty-five percent of the travelers to moderate elevations developed acute mountain sickness, which occurred in 65% of travelers within the first 12 hours of arrival. Fifty-six percent of those with symptoms reduced their physical activity. The odds favoring acute mountain sickness were 3.5 times as large for visitors whose permanent residence was below 3000 feet elevation as for those whose residence was above 3000 feet; 2.8 times as large for visitors with previous symptoms of acute mountain sickness; and twice as large in travelers younger than 60 years. Women, obese persons, those in poor or average physical condition, and those with underlying lung disease also had a higher occurrence of acute mountain sickness (P < 0.05). CONCLUSIONS: Acute mountain sickness occurs in 25% of visitors to moderate altitudes and affects activity in most symptomatic visitors. Persons who are younger, less physically fit, live at sea level, have a history of acute mountain sickness, or have underlying lung problems more often develop these symptoms.
Acute Disease↗
Prospective alterations in therapy for penetrating abdominal trauma.
In a double-blind, randomized study, 170 patients with traumatic perforation of the gastrointestinal tract were administered an advanced-generation cephalosporin. Patients were divided into infection risk groups (< or = 40%, low; 40% to 70%, mid; and > 70%, high) at surgical closure using a logistic regression formula based on four proved risk factors--age, blood replacement, ostomy, and the number of organs injured. Patients in the low group received 2 days of antibiotic therapy; those in the mid to high group received 5 days of antibiotic therapy. Those patients in the low to mid group had primary wound closure; those in the high group had their wounds packed open and closed later. Most of the patients (144 [85%]) were in the low group. Their major and minor infection rates (10% and 12%, respectively) were not significantly different from 145 historic control subjects receiving 5 days of antibiotic therapy (9% major; 14% minor). Patients in the mid to high group showed a greater incidence of major infections (46%) but a similar incidence of minor infections (12%). The results indicate that risk factors can be used to identify low-risk patients who require only short-term antibiotic therapy and primary wound closure. The remaining patients are at greater risk for infection despite prolonged antibiotic therapy and delayed wound closure.
Abdominal Injuries↗
Prevention of epoxy resin dermatitis: failure of manufacturers to use available research information.
Research information is often recommended as a solution for occupational disease and injury. This study asks whether publicly available research information on prevention of a well-documented occupational hazard is acted on by an important sector in industry. The hazard, allergic contact dermatitis (ACD) caused by epoxy resins in paints, is particularly significant for painters, who may have to leave their jobs as a consequence of the condition. No evidence is found, according to a priori criteria, that paint manufacturers/suppliers acted on known prevention measures for epoxy resin ACD that are within their control to implement. The findings suggest that availability of research information alone fails to solve health and safety problems. Recommendations for avenues of direct and indirect enforcement where voluntary implementation is absent in the painting industry are suggested.
Australia↗
Acinetobacter meningitis.
10,468 CSF samples from cases of meningitis in different age groups were cultured during 1988-1991. Acinetobacter calcoaceticus was isolated in 12 (5.6%) of 211 positive cultures. The strain were 100% resistant to ampicillin, cotrimoxazole and tetracycline 50% resistant to cephazolin gentamicin and kanamycin but 100% susceptible to chloramphenicol.
Acinetobacter↗
An Eco RI restriction fragment length polymorphism at the ovine alpha S2-casein (CASAS2) locus.
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Animals↗
Wound infections in orthopedic surgery: effect of extended surveillance on infection rate.
Substantial evidence now exists that ongoing surveillance of surgical wound infections can contribute to reduced infection rates. What is not yet determined is whether surveillance should be limited to the postoperative hospital stay or should be continued after patient discharge. To determine the number of infections occurring after discharge, the authors contacted a random sample of their patients who did not have wound infections during their hospitalization after orthopedic surgery. This was done 30 days after the procedure. The authors selected 273 patients of 1375 who underwent orthopedic surgery over a 7-month period and were able to contact 199 (73%). At the 30-day follow-up 23 patients (11.6%) had wound infections, as judged by wound discharge and physician prescription of antibiotics in 20 and the patient's description of pus issuing from the wound in 3. During the same period postoperative wound infections were found in only 19 (1.5%) of 1278 patients who were subjected to in-hospital surveillance. The authors conclude that, in patients who undergo orthopedic procedures, the majority of wound infections occur after discharge from the hospital and that infection rates based only on in-hospital surveillance greatly under represent true surgical wound infection rates for orthopedic procedures.
Alberta↗
Surgical wound infections occurring in day surgery patients.
The occurrence of surgical wound infection in outpatient day surgery has not been extensively studied despite the increasing popularity of this mode of treatment. The present study was conducted to determine the frequency of surgical wound infections in a day surgery population. We randomly selected during a 6-month period 635 (25%) of 2540 patients undergoing a day surgery procedure in which a skin incision was made. The patients were telephoned 1 month after their procedure by an infection control practitioner. Infection was diagnosed if the patient reported that (1) their physician had made a diagnosis of a wound infection or (2) pus was or had been issuing from the wound. Of the 515 patients contacted, 72% had undergone a clean and 28% a clean-contaminated procedure. Patient risk factors for infection were almost completely absent in our day surgery patients. Twenty-six wound infections were diagnosed, 19 of which were identified by physicians' diagnosis and 7 by patient description, for a rate of 5.05%. Two patients required hospitalization for their infections, and 14 were treated with antibiotics. The clean wound infection rates were 4.62%, less than half the infection rate seen in our patients undergoing inpatient surgery at 1 month follow-up by the same surveillance technique. We conclude that day surgery infection rates are much lower than inpatient surgery infection rates at our facility, probably because of a relative absence of risk factors in the day surgery patients.
Ambulatory Surgical Procedures↗
Inhibition of growth of B16 melanoma by glucocorticoids does not result directly from receptor-mediated inhibition of tumour cells.
The ability of dexamethasone (DM) to slow the growth of B16 melanoma in C57B1 mice was confirmed. Inhibition was dose-related and was demonstrated in the use of established tumours as well as initial transplants. Although glucocorticoid receptors (GR) were present in cultured tumour cells, DM did not reduce growth of B16 in vitro, even at high concentration. This dissociation of effect on growth in vivo and in vitro suggests that DM slows B16 tumour growth in vivo by mechanisms other than GR-mediated inhibition of tumour cells.
Animals↗
High-affinity aldosterone binding in rat liver--a re-evaluation.
The use of sodium molybdate as a stabilizing agent, and a RU26988 to exclude [3H]aldosterone from Type II glucocorticoid receptors, has enabled us to characterize high affinity Type I aldosterone binding sites in rat liver cytosol. In liver cytosols from male rats aldosterone bound with an affinity (Kd-22 degrees C) of 0.6 nmol/l (range 0.3-0.8 nmol/l), and Nmax 1.7 fm/mg protein (s.e.m. = 0.4); specificity of binding was similar to that for Type I sites in classical aldosterone target tissues (aldosterone greater than or equal to corticosterone greater than dexamethasone). Hepatic Type I receptor levels were relatively constant in both male and female rats aged 30-120 days, with levels significantly higher in females. Parallel studies on hepatoma H4 cells showed levels of Type I sites similar to those in normal liver, suggesting a general distribution of such sites throughout liver parenchyma, rather than a concentration in a specific cell type. The function of such Type I sites, and whether or not they are aldosterone-selective in vivo and can thus act as mineralocorticoid receptors, remains to be determined.
Androstanols↗
Cytosol and nuclear levels of thymic progesterone receptors in pregnant, pseudopregnant and steroid-treated rats.
Cytosol and nuclear levels of progesterone receptors in rat thymus and uterus were compared in mature Sprague-Dawley rats under a variety of physiological (non-oestrus, oestrus, pregnancy) and experimental circumstances (pseudopregnancy, oestrogen administration, oestrogen plus progesterone administration). Cytosols and nuclear extracts were charcoal treated to remove endogenous steroids, and incubated overnight at 4 degrees C with the synthetic progestin [3H]R5020 +/- greater than 100-fold R5020, in the presence of greater than 200-fold RU26988 (a highly specific synthetic glucocorticoid) to exclude tracer from glucocorticoid receptors. In the various states examined, levels of progesterone receptors in the uterus were an order of magnitude higher (350-1300 fmol/mg protein) than in the thymus (40-140 fmol/mg protein). In contrast, considerable parallelism between uterus and thymus was seen in terms of the effects of the various manipulations upon tissue levels of progesterone receptors, and of their distribution between cytosol and nuclear compartments.
Animals↗
Pulmonary haemodynamics of the yak, cattle, and cross breeds at high altitude.
The pulmonary arterial pressure of Ladakhi yaks, at an altitude of about 4500m, was not significantly different from that found in yaks bred at low altitude. The pulmonary arterial resistance, however, was slightly but significantly increased in the high altitude group. It is concluded that the yak has adapted genetically to high altitude by largely eliminating the hypoxic pulmonary vasoconstrictor response. The pulmonary arterial pressure and resistance were significantly higher in indigenous Himalayan cattle than in the yaks. The dzo (cow X yak) had pulmonary haemodynamics similar to those of the yak. Half of the stols (dzo X bull) had pulmonary haemodynamics similar to those of the yak, while in the other half the findings resembled those in the cow. The results suggest that the genetic attenuation of the hypoxic vasoconstrictor response is transmitted as a simple autosomal dominant.
Altitude↗
Aldosterone-receptor deficiency in pseudohypoaldosteronism.
Pseudohypoaldosteronism, a syndrome characterized by salt wasting and failure to thrive, usually presents in infancy as high urinary levels of sodium despite hyponatremia, hyperkalemia, hyperreninemia, and elevated aldosterone levels. We have investigated this syndrome for the possibility of abnormal Type I or "mineralocorticoid-like" receptors, which have intrinsic steroid specificity indistinguishable from that of renal mineralocorticoid receptors and are found in many tissues and cells, including mononuclear leukocytes. We have studied three patients with pseudohypoaldosteronism: the 28-year-old index case in Melbourne (Patient 1) and two siblings in Munich, eight and two years of age (Patients 2 and 3); clinically, Patient 3 had a less severe case than his sister. Percoll-separated control monocytes bound [3H]aldosterone with high affinity (Kd approximately 3 nM) and limited capacity (150 to 600 sites per cell). On repeated examination, no [3H]aldosterone binding was found in monocytes from Patients 1 and 2; in Patient 3, the levels were 62 sites per cell, more than 2 S.D. below those of the control. Levels in the parents of the Munich patients (first cousins) were normal. It appears that pseudohypoaldosteronism is caused by a Type I receptor defect, that the defect may be complete or partial, that transmission may be autosomal recessive, and that the study of patients with pseudohypoaldosteronism may indicate physiologic roles for Type I receptors in nonepithelial tissues.
Adult↗
Correlation between cytoplasmic steroid receptors and tumour differentiation and invasion in endometrial carcinoma.
The incidence and levels of cytoplasmic steroid receptors were studied in 155 endometrial carcinomas: oestrogen receptors (ER) were measured in all samples, progesterone receptors (PR) in 148 and androgen receptors (AR) in 118. Well-differentiated adenocarcinomas were significantly more likely to contain ER, PR and AR than were poorly-differentiated tumours, and mean values of ER and PR content were significantly higher in well-differentiated adenocarcinomas than in less-differentiated tumours. Receptor profiles in adenosquamous carcinomas and clear-cell carcinomas were similar to those in adenocarcinomas. Deeply invasive tumours were significantly less likely to be ER, PR or AR positive and, even when positive, such tumours had significantly lower mean levels of ER and PR. Poorly-differentiated tumours were significantly more likely to be ER-negative PR-positive than well-differentiated adenocarcinomas and adenosquamous carcinomas.
Adenocarcinoma↗