Biomedical subjects
Publications and source records attributed to T Lowe.
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We present a novel device which is an alternative to surgical wire for per operative maxillo-mandibular fixation prior to plate placement. It is easy to apply, causes minimal mucosal trauma and can be used in association with elastic chain.
AIMS: To identify the prevalence of post-traumatic psychological symptoms after maxillofacial trauma and prognostic factors related to poor outcome. METHODS: Thirty-nine patients were assessed within 10 days of injury and 24 again 4-6 weeks later using five standardised self-report measures on each occasion and a short structured interview at the time of initial contact. RESULTS: Specific post-traumatic psychological symptoms were present at initial assessment in 21 patients (54%), with 9 (41%) meeting diagnostic criteria for post-traumatic stress disorder at review 4-6 weeks later. Other psychiatric problems, such as anxiety and depression, were identified by the General Health Questionnaire and the Hospital Anxiety and Depression Scale. Characteristics associated with poorer outcome included: a previous history of psychological distress; fear of the unknown, and female sex. CONCLUSION: These findings highlight the adverse psychological effect of maxillofacial trauma both immediately after the event and 4-6 weeks after injury. Proper assessment of injured patients must include psychological aspects and further research is needed to identify the most appropriate response.
Violence in psychiatric inpatient units is a major and growing problem. Research interest has primarily focussed on patient characteristics. The role of staff factors and the antecedents of violent incidents has been neglected, despite the fact that staff factors and behaviour may be more readily amenable to change than patient characteristics. The HOVIS study sought to obtain the views of a sample of mental health nurses in current clinical practice about staff-related factors, which they perceive to contribute to, or protect against, the occurrence of violent incidents. A total of 108 nurses working in psychiatric acute admission, intensive care and low secure units, in two NHS Trusts were interviewed using a specially designed semistructured interview schedule. These nurses identified a variety of behaviours, clinical skills, personal characteristics and interpersonal skills that they believe impact on the occurrence of violent incidents. These findings are discussed in relation to their possible training and managerial implications.
Violence and aggression is common in psychiatric inpatient units. Despite the near universal prevalence of restraint, there is very little published research on either the efficacy or the subjective effects of restraint on staff or patients. In this pilot study, semistructured interviews were given to the patients and staff involved in six untoward incidents in which the patient participant had been subject to manual physical restraint. Participants were interviewed as soon as possible after the occurrence of the incidents. The interviews asked the patient and staff participants to identify and discuss the factors that they found helpful and unhelpful during and in the immediate aftermath of these incidents. The incidents generated strong emotions for all concerned. The patients valued staff time and attention but felt that they received too little attention. Both nurses and patients discriminated between permanent and temporary staff. Patients reported feeling upset, distressed and ignored prior to the incidents and isolated and ashamed afterwards. Postincident debriefing was valued by all but was patchy for staff and rarer still for patients. Patients feared the possibility of being restrained. Half of the patients and several staff members reported that the incidents had reawakened distressing memories of previous traumatic events. Further research on the subjective effects of restraint is urgently needed.
In order to improve leukemia-free survival we evaluated the feasibility and efficacy of autologous transplantation of interleukin-2 (IL-2)-mobilized peripheral blood progenitor cells for adult patients with acute myelogenous leukemia in first remission. Forty-nine consecutive patients (median age 49, range 21-70) with acute myelogenous leukemia in first remission were enrolled on a study of high-dose cytarabine/mitoxantrone consolidation chemotherapy with post-recovery IL-2 used as a method of in vivo purging for the purpose of autologous peripheral blood progenitor cell transplantation. A median of 2.08 x 10(6) CD34+ peripheral blood progenitor cells/kg were infused 1 day after preparative conditioning with 11.25 Gy total body irradiation and cyclophosphamide (120 mg/kg). Forty-one patients received myeloablative chemoradiotherapy followed by the infusion of IL-2-mobilized autologous peripheral blood progenitor cells. The median times to both neutrophil and platelet recovery were 16 days (range, 2-43) and 23 days (8-318+ days), respectively. Twenty-seven patients remain alive with 24 in continued first complete remission. Median remission duration for all eligible patients is 8 months, and actuarial leukemia-free survival is 49+/-15%. The actuarial risk of relapse is 43+/-16%. Toxicity of autologous peripheral blood progenitor cell transplant included treatment-related death in three patients and serious organ toxicity in 12. Advanced age was a negative prognostic factor for leukemia-free survival. Results were compared to an age-matched historical control treated with autologous transplantation of chemotherapy-mobilized progenitor cells; no significant difference in favor of IL-2 mobilization could be demonstrated. Our results demonstrate that autologous transplantation of IL-2-mobilized peripheral blood progenitor cells is feasible in an unselected population of adult patients with acute myelogenous leukemia in first remission with minimal toxicity but no clear evidence of benefit in leukemia-free survival.
In eukaryotes, the C/D box family of small nucleolar (sno)RNAs contain complementary guide regions that are used to direct 2'-O-ribose methylation to specific nucleotide positions within rRNA during the early stages of ribosome biogenesis. Direct cDNA cloning and computational genome searches have revealed homologues of C/D box snoRNAs (called sRNAs) in prokaryotic Archaea that grow at high temperature. The guide sequences within the sRNAs indicate that they are used to direct methylation to nucleotides in both rRNAs and tRNAs. The number of sRNA genes that are detectable within currently sequenced genomes correlates with the optimal growth temperature. We suggest that archaeal sRNAs may have two functions: to guide the deposition of methyl groups at the 2'-O position of ribose, which is an important determinant in RNA structural stability, and to serve as a molecular chaperones to help orchestrate the folding of rRNAs and tRNAs at high temperature.
Small nucleolar RNAs (snoRNAs) are involved in precursor ribosomal RNA (pre-rRNA) processing and rRNA base modification (2'-O-ribose methylation and pseudouridylation). In all eukaryotes, certain snoRNAs (e.g., U3) are transcribed from classical promoters. In vertebrates, the majority are encoded in introns of protein-coding genes, and are released by exonucleolytic cleavage of linearized intron lariats. In contrast, in maize and yeast, nonintronic snoRNA gene clusters are transcribed as polycistronic pre-snoRNA transcripts from which individual snoRNAs are processed. In this article, 43 clusters of snoRNA genes, an intronic snoRNA, and 10 single genes have been identified by cloning and by computer searches, giving a total of 136 snoRNA gene copies of 71 different snoRNA genes. Of these, 31 represent snoRNA genes novel to plants. A cluster of four U14 snoRNA genes and two clusters containing five different snoRNA genes (U31, snoR4, U33, U51, and snoR5) from Arabidopsis have been isolated and characterized. Of these genes, snoR4 is a novel box C/D snoRNA that has the potential to base pair with the 3' end of 5.8S rRNA and snoR5 is a box H/ACA snoRNA gene. In addition, 42 putative sites of 2'-O-ribose methylation in plant 5.8S, 18S, and 25S rRNAs have been mapped by primer extension analysis, including eight sites novel to plant rRNAs. The results clearly show that, in plants, the most common gene organization is polycistronic and that over a third of predicted and mapped methylation sites are novel to plant rRNAs. The variation in this organization among gene clusters highlights mechanisms of snoRNA evolution.
The impact of HIV-associated immunopathogenesis on B cells has been largely associated with indirect consequences of viral replication. This study demonstrates that HIV interacts directly with B cells in both lymphoid tissues and peripheral blood. B cells isolated from lymph node and peripheral blood mononuclear cells (PBMCs) of 4 and 23 chronically infected patients, respectively, demonstrated similar capacities to pass virus to activated HIV-negative PBMCs when compared with CD4(+) cells from the same patients. However, in contrast to T cells, virus associated with B cells was surface bound, as shown by its sensitivity to pronase and the staining pattern revealed by in situ amplification of HIV-1 RNA. Cell sorting and ligand displacing approaches established that CD21 was the HIV-binding receptor on B cells, and that this association was mediated through complement-opsonized virus. These B cells were also found to express significantly lower levels of CD21 compared with HIV-negative individuals, suggesting a direct perturbing effect of HIV on B cells. These findings suggest that B cells, although they themselves are not readily infected by HIV, are similar to follicular dendritic cells in their capacity to serve as extracellular reservoirs for HIV-1. Furthermore, B cells possess the added capability of circulating in peripheral blood and migrating through tissues where they can potentially interact with and pass virus to T cells.
A 39-year-old male developed painful ulceration of the glans penis following simultaneous pancreas and kidney transplantation for end-stage renal failure complicating insulin-dependent diabetes mellitus. Infection was excluded. Diversion of the pancreatic secretions away from the urinary bladder into the bowel resulted in healing.
1. Nursing observation is a key component of psychiatric inpatient nursing care. 2. Patients' experiences of being observed are strongly influenced by the attitudes and behaviors of the observing nurses. 3. Patients prefer to be observed by nurses they know and who talk to them.
This paper reports on 41 patients available for 24 months' follow-up who were entered into a prospective, multi-center study of the safety and efficacy of using the CD Spinal System (Sofamor Danek) containing pedicle screws and rods to treat adult patients with degenerative disc disease. All of these patients were implanted with only the CD Spinal System in an attempt at fusing four levels or less with autogenous bone graft only. At 24 months the results were compared to literature controls in regard to fusion, pain, function, neurological status, and complications. For function and neurological status, the CD Spinal System results were found to be statistically equal to and for fusion, pain, and complications, found to be statistically better than the noninstrumented literature controls with the same disease condition and demographics.
AIMS: To compare methods available to correct the magnification of images that result from the optics of the eye and identify errors, and source of error, of the methods. METHODS: 11 methods were applied to ocular biometry data from three independent cohorts. Each method was compared with the method of Bennett, which uses most biometric data. The difference between each method and Bennett's is the "error" of the method. The relation between the error and axial length, ametropia, and keratometry was explored by linear regression analysis. RESULTS: Methods using axial length had the lowest mean (+0.5 to +2.6%) and standard deviation (0.6 to 1.2%) of errors. Of methods using keratometry and ametropia only, the lowest mean (-1.4% to +4.4%) and standard deviation (2.9 to 4.3%) of errors was found for a new method described in this paper, and that used by the Heidelberg retina tomograph (HRT). The highest mean error (+2.2 to +7.1%) was found for Littmann's method. Littmann's correction was larger than the HRT's by 3.5 to 3.7%. The mean difference between the new and HRT methods and the "abbreviated axial length" method of Bennett is -1.3 to +2.0%. The error of the "keratometry and ametropia" methods is related to axial length. CONCLUSIONS: Methods using axial length are most accurate. The abbreviated axial length method of Bennett differs little from more detailed calculations and is appreciably more accurate than methods using keratometry and ametropia alone. If axial length is unknown, the new and the HRT methods give results closest to the abbreviated axial length method.
Calmodulin is a calcium-binding receptor protein that regulates the contractile protein systems of skeletal muscle and platelets. The levels of platelet calmodulin were measured in twenty-seven adolescents to determine whether there was a relationship between these levels and the progression or the severity of idiopathic scoliosis. The study included seventeen patients who had idiopathic scoliosis of varying severity and patterns and a control group consisting of ten age and sex-matched subjects: eight patients who were being managed for non-scoliosis-related problems and two normal volunteers. Platelets were isolated from the venous blood of all adolescents. The platelets were homogenized and centrifuged, and the calmodulin-containing supernatant was isolated. The level of calmodulin was then measured with use of a radioimmunoassay that employs competitive binding between native, unlabeled calmodulin and 125I-labeled calmodulin. The results showed that the level of platelet calmodulin in the patients who had a progressive curve (more than 10 degrees of progression in the previous twelve months) (3.83 nanograms per microgram of protein) was significantly higher than the level in the patients who had a stable curve (less than 5 degrees of progression in the previous twelve months) (0.60 nanogram per microgram of protein) (p < 0.01); the levels in the stable group and the control group (0.69 nanogram per microgram of protein) were similar. The level of platelet calmodulin appeared to be an independent and possibly more acute predictor of progression of the curve than the Risser sign alone.(ABSTRACT TRUNCATED AT 250 WORDS)
The infant feeding behaviour of 100 women was observed and documented until their infants were 12 months old. Duration of breastfeeding, reasons for weaning and the women's satisfaction with breastfeeding are discussed. Antenatal and perinatal factors are analysed, demonstrating a significant link with education status.
We optimized proton-induced X-ray emission (PIXE) for tissue analysis in a toxicity-disposition study. We used cultured rabbit renal slices as the biological system to demonstrate the use of PIXE analysis. The renal slices were exposed to HgCl2, CdCl2, K2Cr2O7, or NaAsO2 alone or in a mixture. The PIXE analysis provides information on concentrations of elements above atomic number 11, and it is the only analytical technique that can determine 20-30 elements nondestructively in a single, small sample (approximately 5 mg) with detection limits of 1-5 ppm (dry weight). The renal slices are thin targets that yield X-ray emission spectra with low backgrounds and high elemental sensitivities. The nondestructive nature of PIXE and the ability to simultaneously measure uptake of multiple metals and endogenous elements are unique to this methodology.
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A combination of semi-structured interviews and participant observation were used in order to investigate the interventions used by psychiatric nurses when faced with challenging behaviour. The study described 10 such categories of effective interventions: confirming messages, personal control, staff honesty, providing face-saving alternatives, setting limits, use of structure, facilitating expression, monitoring, timing and calming, and non-verbal skills. The report concludes by suggesting that these categories can be used to provide a structure for the analysis of critical incidents from a nursing perspective.