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Biomedical subjects

A Baker

Publications and source records attributed to A Baker.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Neurodevelopmental outcomes of infant multivisceral transplant recipients: a longitudinal study.

UNLABELLED: This longitudinal investigation compares cognitive and physical capabilities of transplant recipients, both before and after receiving an intestinal transplant. METHODS: Using the Bayley Scales of Infant Development, we conducted pretransplant and posttransplant assessments on nine children (4 males, 5 females) who received either an isolated intestine, combined intestine and liver, or multivisceral transplants, with a mean age at transplant of 18 months (range 8-29) and a mean time posttransplant of 2 months (range 1-4 months). RESULTS: Scores on the Mental Developmental Index reflected that a majority (55.6%) of patients who scored in the significantly delayed range prior to transplant remained in the significantly delayed classification after receiving a transplant. In addition, 33.3% showed a decrease in their mental classification; either from "mildly delayed" to "significantly delayed" or from "within normal limits" to "mildly delayed". Results on the Motor Developmental Index demonstrated that 78% of recipients had significant delays both before and after receiving a transplant, while 11.1% fell one standard deviation after transplantation. We found that the majority of children who experience developmental delays prior to transplant are still experiencing delays when they are discharged from inpatient care. In addition, those children receiving multivisceral transplantations, as opposed to an isolated bowel, may be at a much greater risk of developing and retaining both cognitive and physical delays. Early neurodevelopmental evaluations of these patients is essential for early parental education and compliance with early intervention services to maximize potential recovery and ability to obtain normal development.

Child Development↗
PubMedDate not supplied

Neuodevelopmental outcomes for children transplanted under the age of 3 years.

UNLABELLED: Our previous investigations on neurodevelopmental outcomes for intestinal transplanted infants revealed that while some children were able to achieve a normal developmental outcomes, most children suffered from significant motor delays and several experienced severe cognitive delays. In our current investigation, we were especially interested in children who are transplanted before the age of 3 years because the impact of the chronic illness and nutrition impairment on the infant's developing brain may be more severe than those children who receive a liver transplant. METHODS: We evaluated 34 infants using the Bayley Scales of Infant Development. Twenty-seven children received a liver/intestine or multivisceral transplant and seven received a liver transplant. RESULTS: Comparison of the two groups revealed that children receiving an intestine/multivisceral transplant have much poorer outcomes. Seventy-four percent of these children were significantly delayed mentally compared to only 57.14% of the liver transplant infants. Furthermore, 42.86% of the liver-transplanted infants were actually functioning in the normal range posttransplant. The intestinal/multivisceral transplant infants' motor development shows the most striking difference, with 96.3% being severely delayed as compared to liver transplant infants in whom only 71% experienced serious delays. The neurodevelopmental impact of organ failure and transplant before the age of 3 years may depending on the type of organ transplant. Our study found that it may be more likely to expect a good outcome for liver transplant patients than for intestinal and multivisceral transplanted infants. This difference maybe due to the overall severity of the disease and the possible impact of nutritional deficits early in infancy.

Child Development↗
PubMedDate not supplied

Phase II trial of uracil/tegafur (UFT) plus leucovorin in patients with advanced hepatocellular carcinoma.

UNLABELLED: Although UFT 300 mg/m2/day and leucovorin 90 mg/day administered orally in divided doses administered every 8 hours for 28 days repeated every 35 days could be administered safely to patients with advanced hepatomas and good performance status, this combination and schedule has limited activity in treating advanced hepatoma. BACKGROUND/PURPOSE: Biochemical modulation of 5-fluorouracil has yielded higher response rates in hepatoma when compared to treatment with 5-fluorouracil as a single agent, although the impact on survival has been negligible. This study was conducted to determine the activity and evaluate the toxicity of uracil and tegafur in a 4:1 molar concentration ratio (UFT; Bristol-Myers Squibb, Wallingford, CT) plus oral calcium leucovorin in the treatment of patients with advanced hepatocellular carcinoma (hepatoma). PATIENTS AND METHODS: Sixteen patients with advanced measurable hepatocellular carcinoma were enrolled onto the trial. All patients had a Karnofski performance status > or = 60%, platelet count > or = 75,000/micro L, total bilirubin < or = 2.0 x institutional upper limit of normal but otherwise normal liver and kidney function profile and bidimensionally measurable disease by CT or ultrasound examination. None of these patients received prior cytotoxic chemotherapy or radiation therapy for advanced disease. Fourteen patients received 300 mg/m2/d UFT plus 90 mg/d leucovorin administered orally in divided daily doses every 8 hours for 28 days repeated every 35 days. Two patients registered for the trial but did not receive study medication. Objective tumor response, the primary purpose of this trial, was evaluated after two courses of therapy. Other end-points included toxicity, time to progression, and overall survival. RESULTS: Fourteen patients were evaluable for response and toxicity, respectively. No complete or partial responders were observed in this trial. Three patients had stable disease lasting 17 to 22 weeks. Toxicity was mild with severe (grade 3 or 4) liver pain, diarrhea, anorexia/nausea, fatigue, dyspnea, hyperbilirubinemia, anemia, and edema seen in 3 (21%), 2 (14%), 3 (21%), 2 (14%), 1 (7%), 1 (7%), 1 (7%) and 1 (7%) patients, respectively. The most frequent grade I and 2 toxic effects included fever of unknown origin, dyspnea, nausea, vomiting and diarrhea. CONCLUSION: UFT 300 mg/m2/d plus oral leucovorin 90 mg/d administered for 28 days did not demonstrate antitumor activity against advanced hepatomas. Further treatment using this regimen is not recommended for this disease.

Adult↗
PubMedDate not supplied

Fluorescence of dissolved organic matter as a natural tracer of ground water.

The fluorescence properties of dissolved organic matter (DOM) in ground water in the Permian limestone of northeast England is determined from six monitoring boreholes, a private water supply well and from a natural resurgence in a flooded collapse doline in the environs of Darlington, County Durham, northeast England. Measurements of both protein and "fulvic-like" fluorescence was undertaken from January to December 1999. The wavelengths of fulvic-like fluorescence excitation and emission and of protein fluorescence emission were all determined to be sensitive fingerprints of organic matter fluxes through the ground water, with water within the till and within both gypsum and limestone strata deep inside the Magnesian Limestone being differentiated by these parameters. Previous research has suggested that proteins in waters are "young" in age, hence our seasonal variations suggest that we are sampling recently formed DOM. The rapid response of all deep borehole samples suggests relatively rapid ground water flow, probably through karstic cave systems developed in the gypsum and solution widened features in the dolomitic limestone. Our results suggest that use of both protein and fulvic-like fluorescence wavelength variations provides a DOM signature that can be used as a natural tracer.

Benzopyrans↗
PubMedDate not supplied

Effects of allocare-givers on fitness of infants and parents in callitrichid primates.

The effects of callitrichid primate helpers (allocare-givers other than an infant's father) on the survival, reproduction or behavior of infants and parents are reviewed, using both published studies and data from free-ranging golden lion tamarins (Leontopithecus rosalia). Three lines of evidence suggest that helpers may increase their own inclusive fitness: (1) The number of adult males acting as helpers in free-ranging groups is correlated with the number of surviving infants in 3 callitrichid species. However, the lack of a negative correlation with number of infants dying suggests that activities other than direct infant care (e.g. territory defense) may be more important, especially in newly formed groups. (2) In 2 species, captive groups with helpers carry infants for longer periods of time than do groups without helpers. Whether such differences would translate into meaningful survival differences in free-ranging groups is unclear. (3) Helpers reduce the energetic burden of parents by reducing the amount of time they spend transporting or provisioning infants in at least 4 species. Reproductive males are more likely than reproductive females to benefit from the presence of helpers, reducing their investment in infant care activities as the number of helpers in the group increases. In free-ranging golden lion tamarins, the reproductive tenure of males, but not females, increases with the number of helpers in the group, suggesting that a reduction in energetic investment may translate into increased survival. 'Decisions' made by helpers to participate in infant transport are weighed against competing needs for foraging, vigilance, territory defense and, in some cases, prospecting for breeding opportunities. Given this complexity, a sophisticated model may be required to answer the question of how helpers 'decide' to participate in infant care versus other activities.

Animals↗
PubMedDate not supplied

Male:female sex ratio in births resulting from IVF according to swim-up versus Percoll preparation of inseminated sperm.

Two centers have independently reported a higher rate of male to female births following insemination of sperm prepared by a modified swim-up technique. The principle of the modified swim-up is that a small percentage of the x-bearing sperm are the fastest and travel to the top of the supernatant, followed by the y-bearing sperm; the bulk of the x-bearing sperm remain in the pellet. In this technique, the very top layer is discarded and the resulting supernatant is collected, leaving only the pellet. In contrast, with the conventional swim-up technique, the entire supernatant is collected. The study presented herein retrospectively evaluated the male to female sex ratio of births from in vitro fertilization using standard swim-up technique and compared these results to the ratio obtained from separating with Percoll. There were 53% male births with swim-up vs. 54% with Percoll in singleton pregnancies and 51% males with swim-up vs. 40% with Percoll with multiple births. Thus, conventional swim-up alone does not increase percentage of male births.

Cell Separation↗
PubMedDate not supplied

Careers: to be forgotten or managed?

Managers need new skills to plan their own careers and health services organisations will benefit from attending to the career opportunities available to their staff, according to Dr Alison Baker and Dr David Perkins.

Administrative Personnel↗
PubMedDate not supplied

Cecal volvulus occurring after laparoscopic appendectomy.

Less than 2% of cases of intestinal obstruction in adults is caused by cecal volvulus. Although recent abdominal surgery has been implicated, no previous case of cecal volvulus has been reported after laparoscopic appendectomy.

Adult↗
PubMedDate not supplied

Development and implementation of simplified aminoglycoside empiric dosing guidelines.

Poor empiric dosing of aminoglycosides continues to be a problem in many hospitals. Consequently, a two-phase study was undertaken to evaluate gentamicin and tobramycin (G-T) dosing in our institution and to develop practical guidelines to achieve optimum initial G-T serum concentrations. In the pre-intervention phase (phase 1), approximately one-third of 232 G-T treatment courses were initiated with regimens that resulted in low initial serum concentrations. Empiric dosing guidelines were subsequently developed using Pharmacy Pharmacokinetic Service data and literature recommendations. They were validated with patients in phase 1. Compared with earlier dosing methods, the guidelines resulted in initial serum G-T concentrations within the therapeutic range in an equivalent proportion of patients. To simplify the procedure, recommended dosages were based on age, total weight, and serum creatinine only. The guidelines were tabular in format, and prescriber calculations were not required. Pocket and wall chart guidelines were distributed and promoted. During the post-intervention phase (phase 2), the impact of the guidelines was assessed. A review of 232 phase 1 and 203 phase 2 treatment courses revealed an increase in the initial mean dose per interval prescribed after the intervention (p < 0.01). No change in the mean interval was noted. When guidelines were followed, a higher proportion of treatment courses achieved early therapeutic serum concentrations (Cpmax 5-10 mg/L, 80% vs 54%; p < 0.005). The new empiric guidelines appear to be a practical alternative to existing methods of dosing aminoglycosides.

Adult↗