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Biomedical subjects

S Sinclair

Publications and source records attributed to S Sinclair.

At least 19 recordsLinked to original sources
PubMed2006

Surgical debridement of craniocervical necrotizing fasciitis: the window of opportunity.

Craniocervical necrotizing fasciitis (CCNF) has a potentially high morbidity and mortality. Late presentation, shock and disseminated intravascular coagulation are associated with a particularly poor prognosis. Early recognition and aggressive treatment is advised. A case report is presented of a late presentation of necrotizing fasciitis of the face, neck and anterior thoracic wall. Despite adverse prognostic indicators, surgical debridement was performed. Intensive medical treatment included continuous renal replacement therapy and intravenous immunoglobulin. Survival in this case illustrates that the window of opportunity for surgically treating CCNF extends to the advanced stages of the disease, albeit with increased morbidity.

Accidents, Occupational↗
PubMed2001

A critical review of reviews on the treatment of chronic low back pain.

STUDY DESIGN: Systematic literature review. OBJECTIVE: To critically appraise the methodology of systematic reviews of conservative therapies for chronic nonspecific low back pain and to study the relation between the methodologic quality and other characteristics of these reviews. SUMMARY OF BACKGROUND DATA: Systematic reviews offer a concise summary of the evidence on treatment effectiveness, but flaws in their methodology can lead to invalid conclusions with serious implications for quality of patient care. METHODS: Searches of MEDLINE, EMBASE, Psychinfo, and the Cochrane Library were conducted. Titles, abstracts, and articles were reviewed by two blinded authors using three inclusion criteria: 1) chronic nonspecific low back pain, 2) systematic review, and 3) conservative treatment intervention. Data were extracted from each review by three authors. RESULTS: The search strategy retrieved 1102 titles and abstracts; 109 met inclusion criteria. A review of the full text of these articles excluded an additional 73 articles. Data abstraction and methodologic assessment were conducted on 36 articles reviewing 19 discrete interventions. The average quality score was 4.1, ranging from 1 (low) to 7 (high). There was a trend for recent reviews to be of higher quality. Fifty-six percent of the reviews had positive conclusions, but they had lower quality scores compared with those that had negative or uncertain conclusions. There were 27 (73%) qualitative and 10 (27%) quantitative summaries of results. CONCLUSIONS: Although the overall quality of systematic reviews was satisfactory, the quality of the individual papers included in the reviews varied considerably. The reviews often provided contradictory evidence on the effectiveness of a wide range of commonly used conservative interventions for chronic nonspecific low back pain. These findings illustrate the pitfalls of systematic reviews where there are a number of low-quality trials and underscore the need for high-quality primary trials that will allow for more conclusive reviews.

Adolescent↗
PubMed2001

Social influence effects on automatic racial prejudice.

Although most research on the control of automatic prejudice has focused on the efficacy of deliberate attempts to suppress or correct for stereotyping, the reported experiments tested the hypothesis that automatic racial prejudice is subject to common social influence. In experiments involving actual interethnic contact, both tacit and expressed social influence reduced the expression of automatic prejudice, as assessed by two different measures of automatic attitudes. Moreover, the automatic social tuning effect depended on participant ethnicity. European Americans (but not Asian Americans) exhibited less automatic prejudice in the presence of a Black experimenter than a White experimenter (Experiments 2 and 4), although both groups exhibited reduced automatic prejudice when instructed to avoid prejudice (Experiment 3). Results are consistent with shared reality theory, which postulates that social regulation is central to social cognition.

Automatism↗
PubMed2000

Impacts of international trade, services and investment treaties on alcohol regulation.

There is an underlying incompatibility between government efforts to minimize the harm associated with alcohol, particularly by regulating its supply, and international commercial treaties that promote the freer flow of goods, services and investment. These treaties have already forced changes to many government measures affecting alcohol availability and control, primarily by constraining the activities of government alcohol monopolies and by altering taxation regimes. The North American Free Trade Agreement and the World Trade Organization agreements open new avenues for challenges against alcohol control measures. Some of these agreements extend beyond trade, border measures and differential taxation and allow challenges that intrude into areas of non-discriminatory domestic regulation affecting market access, intellectual property, investment and services. Effective protection from these agreements for vital public health measures has rarely been obtained, although it is increasingly essential. The WTO "services" agreement, basically unknown to the public, is currently being re-negotiated and poses the gravest new challenge to policies designed to influence patterns of alcohol use and minimize alcohol-related harm. In future, these international agreements will probably affect adversely those alcohol approaches considered to be the most effective or promising. These include: maintaining effective state monopolies, restricting the number and locations of retail outlets, taxing and regulating beverages according to alcohol strength, restricting commercial advertising, and maintaining and enhancing public alcohol education and treatment programs. These effects can, in turn, be expected to increase the availability and access to alcohol, to lower alcohol taxes, and to increase advertising and promotion, resulting in increased alcohol consumption and associated health problems. Until more balanced international rules are developed, the challenge facing alcohol policy researchers is to defend national and local alcohol measures from further erosion. This will require greater coordination with researchers in other affected sectors, intervention with government representatives in health and related areas and the promotion of alternative approaches to current international commercial agreements.

Alcohol Drinking↗
PubMed2000

Male infertility: nutritional and environmental considerations.

Studies confirm that male sperm counts are declining, and environmental factors, such as pesticides, exogenous estrogens, and heavy metals may negatively impact spermatogenesis. A number of nutritional therapies have been shown to improve sperm counts and sperm motility, including carnitine, arginine, zinc, selenium, and vitamin B-12. Numerous antioxidants have also proven beneficial in treating male infertility, such as vitamin C, vitamin E, glutathione, and coenzyme Q10. Acupuncture, as well as specific botanical medicines, have been documented in several studies as having a positive effect on sperm parameters. A multi-faceted therapeutic approach to improving male fertility involves identifying harmful environmental and occupational risk factors, while correcting underlying nutritional imbalances to encourage optimal sperm production and function.

Acupuncture Therapy↗
PubMed1999

Migraine headaches: nutritional, botanical and other alternative approaches.

Migraine headaches are an increasingly common health problem with a wide range of potential etiological factors. Stress, food allergies, neuroendocrine imbalances and nutritional deficiencies all may contribute to migraine attacks. Many nutritional and botanical therapies aim to reduce migraine incidence by decreasing platelet aggregation and preventing the release of vasoactive neurotransmitters, and avoiding triggering foods. This article reviews much of the research on nutritional, botanical, dietary, and other alternative approaches to the treatment and prevention of migraines.

Complementary Therapies↗
PubMed1998

Preventing disability from work-related low-back pain. New evidence gives new hope--if we can just get all the players onside.

Despite the publication in the mid-1990s of comprehensive practice guidelines for the management of acute low-back pain, both in the United States and elsewhere, this ubiquitous health problem continues to be the main cause of workers' compensation claims in much of the Western world. This paper represents a synthesis of the intervention studies published in the last 4 years and is based on a new approach to categorizing these studies that emphasizes the stage or phase of back pain at the time of intervention and the site or agent of the intervention. Current thinking suggests that medical management in the first 3-4 weeks after the onset of pain should be generally conservative. Several studies of rather heterogeneous interventions focusing on return to work and implemented in the subacute stage (3-4 to 12 weeks after the onset of pain) have shown important reductions in time lost from work (by 30% to 50%). There is substantial evidence indicating that employers who promptly offer appropriately modified duties can reduce time lost per episode of back pain by at least 30%, with frequent spin-off effects on the incidence of new back-pain claims as well. Finally, newer studies of guidelines-based approaches to back pain in the workplace suggest that a combination of all these approaches, in a coordinated workplace-linked care system, can achieve a reduction of 50% in time lost due to back pain, at no extra cost and, in some settings, with significant savings.

Absenteeism↗
PubMed1998

Open earmold fittings for improving aided auditory localization for sensorineural hearing losses with good high-frequency hearing.

OBJECTIVE: We tested the hypothesis that the use of nonoccluding earmolds for hearing aid fittings could optimize auditory localization in the vertical plane for people with moderate, low-frequency hearing losses and good hearing at frequencies above 4000 Hz. This benefit was expected to arise from leaving the pinna unobstructed and by optimizing hearing (unaided) for frequencies above the hearing aid's limit. DESIGN: Twenty-two participants had hearing losses greater than 30 dB over the range 250 to 2000 Hz and had minimal losses (< 30 dB) at 6000 Hz and 8000 Hz. Their auditory localization was tested, using a horizontal arc and a vertical arc of loudspeakers, when listening unaided and when fitted bilaterally with Behind The Ear hearing aids with three earmold types--closed (occluded), open (partly occluded), sleeve (nonoccluded). RESULTS: Localization of vertical plane sound sources was significantly poorer for the closed earmold condition than for unaided. The open and sleeve conditions were better than the closed condition, and, for the sleeve earmold, vertical localization was almost equal to that unaided. The capacity to benefit from using open rather than closed earmolds was related to hearing level; people with the best hearing at 4000, 6000, and 8000 Hz received the most benefit. There was limited evidence that open earmolds also can be advantageous for some aspects of horizontal plane localization. CONCLUSIONS: Nonoccluding earmolds optimize aided vertical localization for hearing aid users with good high-frequency hearing. The "sleeve" earmold, so far used only in research, may be a useful clinical option.

Adolescent↗
PubMed1998

Improvement in aided sound localization with open earmolds: observations in people with high-frequency hearing loss.

Sound localization ability was tested in nine people with marked, bilateral, high-frequency hearing loss and little or no low-frequency loss. They had previously been fitted bilaterally with behind-the-ear hearing aids and closed earmolds and showed poorer aided than unaided localization performance. Further testing was conducted in unaided and aided conditions, with the aids coupled to closed, open, and "sleeve" (extra-open) earmolds. Closed earmolds affected localization, particularly in the frontal horizontal plane, but performance was restored to unaided levels in both of the open earmold conditions. In the lateral vertical plane, localization was found to correlate with the extent of difference between low- and high-frequency hearing levels. That result is discussed in terms of a dynamic, low-frequency localization cue. Open earmolds are argued to improve aided sound localization for the present sample by permitting undistorted access to low-frequency interaural time/phase differences.

Aged↗
PubMed1998

Chinese herbs: a clinical review of Astragalus, Ligusticum, and Schizandrae.

Although Astragalus, Ligusticum and Schizandrae have a long history of medicinal use within the traditional Chinese system, only recently has the West begun to understand their pharmacological possibilities and clinical applications. Astragalus has demonstrated a wide range of immunopotentiating effects and has proven efficacious as an adjunct cancer therapy. Ligusticum, and its active components, have been investigated for enhancement of the immune system, treatment of ischemic disorders, and as an anti-inflammatory. Clinically, the hepato-protective and antioxidant actions of Schizandrae have proven beneficial in the treatment of chronic viral hepatitis.

Animals↗
PubMed1997

Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial.

OBJECTIVES: To assess whether intraoperative intravascular volume optimisation improves outcome and shortens hospital stay after repair of proximal femoral fracture. DESIGN: Prospective, randomised controlled trial comparing conventional intraoperative fluid management with repeated colloid fluid challenges monitored by oesophageal Doppler ultrasonography to maintain maximal stroke volume throughout the operative period. SETTING: Teaching hospital, London. SUBJECTS: 40 patients undergoing repair of proximal femoral fracture under general anaesthesia. INTERVENTIONS: Patients were randomly assigned to receive either conventional intraoperative fluid management (control patients) or additional repeated colloid fluid challenges with oesophageal Doppler ultrasonography used to maintain maximal stroke volume throughout the operative period (protocol patients). MAIN OUTCOME MEASURES: Time declared medically fit for hospital discharge, duration of hospital stay (in acute bed; in acute plus long stay bed), mortality, perioperative haemodynamic changes. RESULTS: Intraoperative intravascular fluid loading produced significantly greater changes in stroke volume (median 15 ml (95% confidence interval 10 to 21 ml)) and cardiac output (1.2 l/min (0.1 to 2.3 l/min)) than in the conventionally managed group (-5 ml (-10 to 1 ml) and -0.4 l/min (-1.0 to 0.2 l/min)) (P < 0.001 and P < 0.05, respectively). One protocol patient and two control patients died in hospital. In the survivors, postoperative recovery was significantly faster in the protocol patients, with shorter times to being declared medically fit for discharge (median 10 (9 to 15) days v 15 (11 to 40) days, P < 0.05) and a 39% reduction in hospital stay (12 (8 to 13) days v 20 (10 to 61) days, P < 0.05). CONCLUSIONS: Proximal femoral fracture repair constitutes surgery in a high risk population. Intraoperative intravascular volume loading to optimal stroke volume resulted in a more rapid postoperative recovery and a significantly reduced hospital stay.

Aged↗
PubMed1997

Subretinal microsurgery with gradient index endoscopes.

State-of-the-art subretinal surgery involves a standard three-port pars plana entry, followed by an iatrogenic retinotomy to access the subretinal space. Subretinal manipulations through a small retinotomy are made possible by specially designed instruments. As the surgeon looks through the vitreous cavity, all subretinal maneuvers are obscured by the overlying retina. Consequently, the surgeon is operating 'blindly' and has to rely on 'feeling' rather than direct visualization. Micro-endoscopic viewing systems are the ideal solution for visualization during subretinal surgery. Until now, such endoscopes were either too large for intraocular use or lacked sufficient resolution, especially at a short working distance. Recently, a gradient index (GRIN) endoscope was developed (Insight Instruments, Inc., Lake Mary, Fla., USA) combining a small diameter (0.89 mm, 20 gauge) and incorporating excellent optical resolution, even at extremely close working distances. After ballooning a limited part of the retina without creating a retinal hole, the 20-gauge GRIN endoscope can be introduced into the subretinal space through the sclera and choroid, posterior to the pars plana. Surgical instruments can then be introduced into the subretinal space through a second neighboring sclerotomy. Thus, subretinal surgery can be performed under direct endoscopic control. As a result of direct visualization, the surgeon may perform certain surgical procedures with greater accuracy, i.e., subretinal neovascular membranes may be dissected meticulously from the neurosensory retina and retinal pigment epithelium, minimizing damage to both structures. The feeding choroidal vessel can be identified and directly coagulated, which is usually very difficult during conventional subretinal surgery. Endoscopic subretinal surgery is thus a significant improvement over conventional methods, avoiding the need for a retinotomy and increasing the safety and facility of the surgery itself.

Endoscopy↗
PubMed1997

Effects of speed and different types of treadmill on the range of motion of the lower extremities.

This study examined the range of motion of the lower extremities in 20 subjects (10 men, 10 women) exercising on treadmills. Of particular interest was how this parameter was affected by speed and different types of treadmill. Analysis indicated that there were statistically significant differences in the hip and knee joints, but not in the ankle joint for two selected types of treadmill set at the same speed.

Ankle Joint↗
PubMed1995

Pattern of disease after murine hepatitis virus strain 3 infection correlates with macrophage activation and not viral replication.

Murine hepatitis virus strain (MHV-3) produces a strain-dependent pattern of disease which has been used as a model for fulminant viral hepatitis. This study was undertaken to examine whether there was a correlation between macrophage activation and susceptibility or resistance to MHV-3 infection. Peritoneal macrophages were isolated from resistant A/J and susceptible BALB/cJ mice and, following stimulation with MHV-3 or lipopolysaccharide (LPS), analyzed for transcription of mRNA and production of interleukin-1 (IL-1), tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGF-beta), mouse fibrinogen-like protein (musfiblp), tissue factor (TF), leukotriene B4, and prostaglandin E2 (PGE2). Macrophages from BALB/cJ mice produced greater amounts of IL-1, TNF-alpha, TGF-beta, leukotriene B4, and musfiblp following MHV-3 infection than macrophages from resistant A/J mice, whereas in response to LPS, equivalent amounts of IL-1, TNF-alpha, TGF-beta, and TF were produced by macrophages from both strains of mice. Levels of mRNA of IL-1, TNF-alpha, and musfiblp were greater and more persistent in BALB/cJ than in A/J macrophages, whereas the levels and kinetics of IL-1, TNF-alpha, and TF mRNA following LPS stimulation were identical in macrophages from both strains of mice. Levels of production of PGE2 by MHV-3-stimulated macrophages from resistant and susceptible mice were equivalent; however, the time course for induction of PGE2, differed, but the total quantity of PGE2 produced was insufficient to inhibit induction of musfiblp, a procoagulant known to correlate with development of fulminant hepatic necrosis in susceptible mice. These results demonstrate marked differences in production of inflammatory mediators to MHV-3 infection in macrophages from resistant A/J and susceptible BALB/cJ mice, which may explain the marked hepatic necrosis and fibrin deposition and account for the lethality of MHV-3 in susceptible mice.

Animals↗
PubMed1994

Acute appendicitis in young children in the Belfast urban area: 1985-1992.

Eighty-one cases of acute appendicitis in children aged less than six years were identified in the Belfast urban area between 1985 and 1992. Appendiceal perforation, found in 43%, was related to symptom duration but not to age at presentation. Prolongation of symptoms was related to parental delay in seeking medical advice (52% > 36 hours), delayed or inappropriate general practitioner referral to hospital (19%) and diagnostic delay following surgical consultation (12% > 12 hours). Diagnostic delay in hospital was usually the result of nonspecificity of symptoms and signs and was therefore largely unavoidable. Delayed referral from general practice did not contribute unnecessarily to appendiceal perforation, and given that an individual general practitioner will see a case of preschool appendicitis once in 30 years, diagnostic accuracy was remarkably high.

Appendectomy↗