Tube-pedicle construction of an exposed mandible following an electrical injury.
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Adolescent↗
Biomedical subjects
D Thomas
Publications and source records attributed to D Thomas.
Optical coherence tomography--a review of the principles and contemporary uses in retinal investigation.
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Humans↗
Retinal telangiectasia in association with macular hole formation.
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Female↗
[MR-coronary angiography: comparison of SSFP and spoiled GRE sequence (bright blood technique) and a TSE sequence (black blood technique) in healthy volunteers].
PURPOSE: Comparison of a free breathing steady-state free precession (SSFP), a spoiled gradient-echo (GRE) and a turbo spin-echo sequence (TSE) for imaging of the coronary arteries (MRCA) in healthy volunteers. MATERIALS AND METHODS: Twenty-two healthy volunteers were imaged with a standard clinical scanner (1.5 T, Intera, Philips), with the right coronary system imaged in 11 and the left coronary system in the other 11 volunteers. Images were obtained with a 3D-SSFP (balanced TFE, TR 6.2 ms, TE 3.1 ms, alpha 65 degrees ), a 3D-GRE (TFE, TR 7.2 ms, TE 2.2 ms, alpha 30 degrees ) and a 2D-TSE (Dual-IR, TR 2RR, TE 25 ms) sequence. The in plane resolution was 0.7 x 0.8 mm for both the SSFP and GRE sequence with an effective slice thickness of 1.5 mm. For the TSE sequence, an in-plane resolution of 0.7 x 0.9 mm and a slice thickness of 3.0 mm were used. All investigations were performed using prospective navigator gating and slice-following technique. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for the blood pool to myocardium and blood pool to epicardial fat were calculated. Image quality and measurement artifacts were assessed for all sequences by 5 independent investigators using a 4- and 5-point grading scale. RESULTS: CNR was significantly higher for the GRE sequence compared with the SSFP sequence and TSE sequence (mean 20.8 +/- 4.8 vs. 14.6 +/- 5.0 and 10.1 +/- 3.7 for blood pool to myocardium; mean 27.5 +/- 6.3 vs. 16.4 +/- 5.4 and 18.1 +/- 5.7 for blood pool to fat). The SNR revealed no significant differences between the SSFP and GRE sequences. The SSFP and the TSE sequences showed significantly more artefacts than the spoiled GRE sequence. Image quality was graded slightly higher for the GRE than for the SSFP sequence for the right coronary system, while there was no substantial difference in the left coronary system (median 2.1 +/- 0.6 and 2.5 +/- 0.6 vs. 2.5 +/- 0.8 and 2.6 +/- 0.7 for the right and left coronary system). In comparison, image quality was lower with the TSE sequence (median 2.9 +/- 0.5 for the right coronary system with p < 0.05 vs. GRE sequence and 3.0 +/- 0.3 for the left coronary system). CONCLUSION: For the scan parameters chosen in this study, the GRE-sequence represents the most robust technique for imaging of the coronary arteries. Currently, the TSE sequence is no alternative.
Adult↗
Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant.
The indications for transfusing fresh-frozen plasma (FFP), cryoprecipitate and cryosupernatant plasma are very limited. When transfused they can have unpredictable adverse effects. The risks of transmitting infection are similar to those of other blood components unless a pathogen-reduced plasma (PRP) is used. Of particular concern are allergic reactions and anaphylaxis, transfusion-related acute lung injury, and haemolysis from transfused antibodies to blood group antigens, especially A and B. FFP is not indicated in disseminated intravascular coagulation without bleeding, is only recommended as a plasma exchange medium for thrombotic thrombocytopenic purpura (for which cryosupernatant is a possible alternative), should never be used to reverse warfarin anticoagulation in the absence of severe bleeding, and has only a very limited place in prophylaxis prior to liver biopsy. When used for surgical or traumatic bleeding, FFP and cryoprecipitate doses should be guided by coagulation studies, which may include near-patient testing. FFP is not indicated to reverse vitamin K deficiency for neonates or patients in intensive care units. PRP may be used as an alternative to FFP. In the UK, PRP from countries with a low bovine spongiform encephalopathy incidence is recommended by the Departments of Health for children born after 1 January 1996. Arrangements for limited supplies of single donor PRP of non-UK origin are expected to be completed in 2004. Batched pooled commercially prepared PRP from donors in the USA (Octaplas) is licensed and available in the UK. FFP must be thawed using a technique that avoids risk of bacterial contamination. Plastic packs containing any of these plasma products are brittle in the frozen state and must be handled with care.
Adult↗
A bispecific antibody against human IgE and human FcgammaRII that inhibits antigen-induced histamine release by human mast cells and basophils.
BACKGROUND: FcgammaRIIB are low-affinity immunoglobulin (Ig)G receptors that we previously demonstrated to negatively regulate IgE-induced mast cell activation when coaggregated with FcepsilonRI. Here, we engineered and characterized a bispecific reagent capable of coaggregating FcgammaRIIB with FcepsilonRI on human mast cells and basophils. METHODS: A bispecific antibody was constructed by chemically crosslinking one Fab' fragment against human IgE and one Fab' fragment against human FcgammaRII. This molecule was used to coaggregate FcepsilonRI with FcgammaRII on human mast cells and basophils sensitized with human IgE antibodies, and the effect of coaggregation was examined on mediator release upon challenge with specific antigen. RESULTS: When used under these conditions, this bispecific antibody not only failed to trigger the release of histamine by IgE-sensitized cells, but it also prevented specific antigen from triggering histamine release. Comparable inhibitions were observed with mast cells and basophils derived in vitro from cord blood cells and with peripheral blood basophils. CONCLUSIONS: The bispecific antibody described here is the prototype of similar molecules that could be used in new therapeutic approaches of allergic diseases based on the coaggregation of activating receptors, such as FcepsilonRI, with inhibitory receptors, such as FcgammaRIIB, that are constitutively expressed by mast cells and basophils.
Antibodies, Bispecific↗
The physiology of oxygen delivery.
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Anemia↗
Effect of massage of the hamstring muscle group on performance of the sit and reach test.
OBJECTIVE: To investigate if a single massage of the hamstring muscle group would alter the performance of the sit and reach test. METHODS: Before treatment, each of 11 male subjects performed the sit and reach test. The treatment consisted of either massage of the hamstring muscle group (both legs, total time about 15 minutes) or supine rest with no massage. Performance of the sit and reach test was repeated after treatment. Each subject returned the subsequent week to perform the tests again, receiving the alternative treatment relative to their initial visit. Mean percentage changes in sit and reach scores after treatment were calculated for the massage and no massage treatments, and analysed using Student's t tests. RESULTS: Mean (SD) percentage changes in sit and reach scores after massage and no massage were small (6.0 (4.3)% and 4.6 (4.8)% respectively) and not significantly different for subjects with relatively high (15 cm and above) values before treatment. Mean percentage changes in sit and reach scores for subjects with relatively low values before treatment (below 15 cm) were large (18.2 (8.2)% and 15.5 (16.2)% respectively), but no significant differences were found between the massage and no massage groups. CONCLUSIONS: A single massage of the hamstring muscle group was not associated with any significant increase in sit and reach performance immediately after treatment in physically active young men.
Adult↗
Diagnosis of genital herpes by real time PCR in routine clinical practice.
BACKGROUND: Virus isolation in cell culture is the recognised diagnostic gold standard for genital herpes. Although increasing evidence indicates that polymerase chain reaction (PCR) provides a more rapid and sensitive diagnostic method, its implementation in routine diagnostic settings has been limited by concerns over contamination and cost. OBJECTIVE: To evaluate the feasibility of replacing virus culture with PCR for the diagnosis of genital herpes in settings serving large populations of genitourinary medicine (GUM) attendees. METHODS: Genital swabs collected from 233 consecutive GUM attendees with suspected genital herpes were tested in parallel by virus culture and automated real time PCR. Three specimen preparation methods were evaluated and the assay reliability was assessed by repeat testing, comparison with a commercially available assay, and herpes simplex virus (HSV) sequence analysis. Probe melting temperatures (Tm) were used to differentiate between HSV types without additional post-PCR steps. RESULTS: HSV was detected in 79/233 (34%) samples by virus culture and 132/233 (57%) samples by PCR. PCR significantly increased HSV detection in both early (< 5 days) and late (> or = 5 days) presentations and in both first and recurrent episodes. HSV detection and typing by PCR was achieved within less than 4 hours leading to a significant reduction in labour compared to virus culture. Most specimens (120/132, 91%) were typed as HSV-2. Results were highly reproducible. CONCLUSIONS: Real time PCR is a highly reproducible, rapid, and labour efficient method for HSV detection in genital swabs. Its implementation is feasible in routine diagnostic settings.
Base Sequence↗
Recent trends in HIV and other STIs in the United Kingdom: data to the end of 2002.
Sexual health in the United Kingdom has deteriorated in recent years with further increases in HIV and other sexually transmitted infections (STIs) reported in 2002. This paper describes results from the available surveillance data in the United Kingdom from the Health Protection Agency and its national collaborators. The data sources range from voluntary reports of HIV/AIDS from clinicians, CD4 cell count monitoring, a national census of individuals living with HIV, and the Unlinked Anonymous Programme, to statutory reports of STIs from genitourinary medicine (GUM) clinics and enhanced STI surveillance systems. In 2002, an estimated 49500 adults aged over 15 years were living with HIV in the United Kingdom, of whom 31% were unaware of their infection. Diagnoses of new HIV infections have doubled from 1997 to 2002, mainly driven by heterosexuals who acquired their infection abroad. HIV transmission also continues within the United Kingdom, particularly among homo/bisexual men who, in 2002, accounted for 80% of all newly diagnosed HIV infections acquired in the United Kingdom. New diagnoses of syphilis have increased eightfold, and diagnoses of chlamydia and gonorrhoea have doubled from 1997 to 2002 overall; STI rates disproportionately affect homo/bisexual men and young people. Effective surveillance is essential in the provision of timely information on the changing epidemiology of HIV and other STIs; this information is necessary for the targeting of prevention efforts and through providing baseline information against which progress towards targets can be monitored.
Bisexuality↗
[Arrhythmogenic right ventricular dysplasia].
Congestive cardiac failure could be as important as cardiac arrhythmias in the natural history of arrhythmogenic right ventricular dysplasia. This can be related to the progressive replacement of myocardium by fat and fibrosis of the right ventricle. The left ventricle may also be involved by the same disease process. Moreover, inflammation can be superimposed on ARVD, resulting in a wide spectrum of clinical presentation which can mimick idiopathic dilated cardiomyopathy. Right ventricular cardiac failure has been controlled by anterior dynamic cardiomyoplasty.
Arrhythmogenic Right Ventricular Dysplasia↗
Dynamic digital image analysis: emerging technology for particle characterization.
The feasibility of applying dynamic imaging analysis technology to particle characterization has been evaluated for application in the water sector. A system has been developed which captures in-situ images of suspended particles in a flowing sample stream and analyzes these images in real time to determine particle size and concentration. The technology can measure samples having a wide range of particle sizes (approximately 1.5 to 1,000 microm equivalent circular diameter) and concentrations (<1 to >1 million/ml). The system also provides magnified images of particles for visual analysis of properties such as size, shape and grayscale level. There are no sample preparation requirements and statistically accurate results are produced in less than three minutes per sample. The overall system architecture is described. The major design challenges in developing a practical system include obtaining adequate contrast for the range of particle materials found in typical water samples and achieving this under operating conditions permitting an adequate sample processing rate for real time feedback of results. Performance of the instrument is reported in reference to industry accepted particle standards and applications as an analytical tool for the water industries are considered.
Automation↗
Questionnaire survey on the use of computerisation in dental practices across the Thames Valley Region.
OBJECTIVES: To investigate the extent of and attitudes to computerisation in dental practices across the Thames Valley Strategic Health Authority Region. DESIGN: Postal questionnaire survey. RESULTS: A response rate of 88% was achieved. Most (77%) of the practices were using computerised systems or were planning to do so soon. The main reasons for not using computers were that computerisation was not currently necessary (56%), practice staff were reluctant to move to electronic systems (24%), or because computer systems were perceived as too expensive (19%). Computerised systems were used mainly for transmitting dental practice board data, or managing patient and financial records. Only 45% of practices had access to the internet and electronic mail (email). Forty-nine percent of practices thought that it was important to have access to email, 46% to the internet and 40% to NHSnet. Many practices requested training for staff in a variety of areas including managing databases and setting up web-sites. CONCLUSIONS: Despite the advantages of using computerised systems, many dental practices were only using them to a limited extent. Training and follow-up support may encourage dental practice teams to develop more positive attitudes towards computerisation and encourage them to use computers more extensively in clinical practice.
Attitude of Health Personnel↗
Incident hepatitis C virus in women with human immunodeficiency virus infection.
Individuals infected with human immunodeficiency virus type 1 (HIV-1) are frequently coinfected with hepatitis C virus (HCV). Acute HCV infection is often asymptomatic and poorly understood. We conducted a historical prospective study of HCV antibody and viremia in plasma samples obtained during 1994-1999 from a cohort of initially HIV-1-infected, HCV-uninfected women and from HIV-1-HCV-uninfected women. Twenty-two (1.5%) of 1517 experienced seroconversion. Of these, 14 (64%) truly acquired a new infection as assessed by enzyme immunoassay response and new-onset viremia. The incidence rate in HIV-1-infected women was 2.7 cases per 1000 person-years; it was 3.3 cases per 1000 person-years in HIV-1-seronegative women (relative risk, 1.21; P=.75). Acquisition of HCV was associated with any history of drug use (P<.01). Five of 12 viremic, seroconverting individuals cleared viremia. Incident HCV infection among HIV-1-infected and HIV-1-uninfected women was low. It was linked to drug use and commonly resolved.
Adult↗
Smoking cessation interventions in the Oxford region: changes in dentists' attitudes and reported practices 1996-2001.
OBJECTIVES: To investigate dentists' current beliefs and practices (2001) with respect to smoking cessation interventions and any changes that might have occurred since the last survey in 1996. DESIGN: Postal questionnaire survey. SETTING: General dental practitioners on the health authority lists of Berkshire, Buckinghamshire, Oxfordshire and Northamptonshire. RESULTS: A response rate of 71% (696/984) was achieved. The majority of dentists (88.6%) thought that dentists should encourage their patients to stop smoking (increase of 6.3% since 1996; 95%CI 2.6, 10.2; p=0.001), although only 42.2% believed dentists were effective in this area (non-significant increase of 4.8% since 1996). Only 48.4% routinely recorded their patient's smoking status (increase of 30.3% since 1996; 95%CI 25.4, 34.9; p<0.001) and only 26.9% always discussed the habit with smokers (increase of 9.5% since 1996; 95%CI 5.1, 13.9; p<0.001). Less than 10% reported a good knowledge of NRT or Bupropion. About half of respondents requested more training and resources. CONCLUSIONS: Dentists generally have positive attitudes to being involved in smoking cessation interventions, but although there are significant increases between 1996 and the current survey, few are active in this area. More training and resources may encourage dentists to be more proactive in helping their patients to stop smoking.
Attitude of Health Personnel↗
Acute release of plasminogen activator inhibitor-1 in ST-segment elevation myocardial infarction predicts mortality.
BACKGROUND: A few studies have suggested that von Willebrand factor (vWF) or plasminogen activator inhibitor-1 (PAI-1) can be associated with outcomes of acute coronary syndromes. The present study was designed to assess the acute release of these markers in ST-segment elevation myocardial infarction (STEMI) and their relations to death. METHODS AND RESULTS: In 153 consecutive patients with STEMI, vWF and PAI-1 antigens were measured on admission (H0) and 24 hours later (H24). At 30 days, the death rate was 7.2%. Heart failure (Killip stage > or =3) on admission was present in 13.7% of patients. The acute release of PAI-1 (H24-H0, in ng/mL) and of vWF (H24-H0, in %) was dramatically higher in patients who died than in those who survived (46.9+/-26.3 versus -0.6+/-2.8 ng/mL, P=0.0001 and 65.8+/-20.0% versus 10.0+/-5.1%, P=0.004 for PAI-1 and vWF, respectively) and in patients developing heart failure compared with those without (24.8+/-10.1 versus -1.1+/-3.3 ng/mL, P=0.004 and 47.3+/-11.0% versus 8.1+/-5.6%, P=0.005 for PAI-1 and vWF, respectively). The release of PAI-1 correlated weakly with the left ventricular ejection fraction (R=-0.195, P=0.01) and the peak of troponin (R=0.149, P=0.045). Postangioplasty TIMI-3 flow and the acute release of PAI-1 were the only 2 independent predictors of death at 30 days. CONCLUSIONS: The acute release of vWF and PAI-1 over the first 24 hours of STEMI is associated with death and heart failure. The acute rise of PAI-1 is also a strong independent predictor of death at 30 days.
Aged↗
Participation of UK dentists in continuing professional development.
INTRODUCTION: This paper reports participation of dentists in continuing professional development (CPD) and factors affecting participation. METHOD: All general dental practitioners (GDPs) in three deaneries in England were surveyed. The overall response rate was 54% (n = 2082); by deanery it was 68% West Midlands, 45% South West and 44% Anglia. Findings across deaneries were remarkably similar. Comparisons with national data show no notable bias in the sample for gender, owners/partners and age/experience. RESULTS: Most frequent forms of CPD were journal reading and courses in which almost all engaged. A score based on individual participation in CPD over the 12-month period was calculated. The mean score (hours) for participation in verifiable CPD was 31 (median 25) and for general, 29 (median 29). In terms of the GDC's Lifelong Learning Scheme, 57% were already undertaking 50 hours. Net of other effects, those less likely to be doing 50 hours are those with more years in practice and single-handed practitioners. Greater access to courses and media-based CPD is desired. CONCLUSION: Certain groups of dentists will need support to meet the requirements of the GDC's Lifelong Learning Scheme. Statutory peer review or clinical audit will significantly alter the CPD profile of most dentists. This has implications for facilitators.
Age Factors↗
Familial hepatoblastoma and APC gene mutations: renewed call for molecular research.
Recent findings have increased our understanding of the molecular mechanisms involved in the pathogenesis of hepatoblastoma and their relationship to the molecular pathology of familial adenomatous polyposis (FAP). Here, we describe hepatoblastoma in siblings who share a gene mutation for FAP inherited from their father. This observation confirms the link between these diseases and has implications for future molecular research. We also raise the question; should other members of 'at-risk' families be screened following a new diagnosis of either hepatoblastoma or FAP?
Biomedical Research↗