Biomedical subjects

J E Wells

Publications and source records attributed to J E Wells.

At least 19 recordsLinked to original sources

PubMed2006

Intrinsic measurement bias on computed tomography scout view is unpredictable: Computed tomography pelvimetry using a phantom.

Our aim was to determine the degree of bias in CT scanogram measurements. We obtained standard lateral and anteroposterior (AP) pelvimetry scanograms of a phantom pelvis after placing ball bearings or aluminium rods to mark bony landmarks. Computed tomography pelvimetry was carried out at the manufacturer-recommended table height on two commercial CT scanners and at 10-mm increments up to 50 mm above and below this height. The AP inlet, AP outlet, interspinous distance and transverse diameters were each measured three times for each scanogram. The true measurements were obtained directly from the disassembled phantom. Bias was defined as the difference between the CT measurement and the true measurement. Observer error was negligible. The transverse diameter was overestimated at high table positions and underestimated at low table positions on both scanners (+6 to -10 mm). After correcting for geometric distortion, up to 6 mm bias was still present. The point at which no bias occurred was different for each scanner and did not correspond to the manufacturers' recommended table height. The outlet was overestimated on both scanners by up to 5 mm. The true inlet measurement was overestimated by 1.2 mm. The interspinous distance was minimally underestimated on both scanners. The measurements on CT scanogram were underestimated or overestimated in an inconsistent and unpredictable fashion, varying from one type of measurement to another and from CT scanner to CT scanner. This has implications for the accuracy and clinical utility of measurements obtained from a CT scanogram.

Analysis of Variance↗

PubMed2006

Influence of genotype and diet on steer performance, manure odor, and carriage of pathogenic and other fecal bacteria. II. Pathogenic and other fecal bacteria.

This study assessed the influence of cattle genotype and diet on the carriage and shedding of zoonotic bacterial pathogens and levels of generic Escherichia coli in feces and ruminal contents of beef cattle during the growing and finishing periods. Fifty-one steers of varying proportions of Brahman and MARC III [0 (15), 1/4 (20), 1/2 (7), and 3/4 Brahman (9)] genotypes were divided among 8 pens, such that each breed type was represented in each pen. Four pens each were assigned to 1 of 2 diets [100% chopped bromegrass hay or a diet composed primarily of corn silage (87%)] that were individually fed for a 119-d growing period, at which time the steers were switched to the same high-concentrate, corn-based finishing diet and fed to a target weight of 560 kg. Feces or ruminal fluid were collected and analyzed at alternating intervals of 14 d or less. Generic E. coli concentrations in feces or ruminal fluid did not differ (P > 0.10) by genotype or by growing diet in the growing or finishing periods. However, the concentrations in both feces and ruminal fluid increased in all cattle when switched to the same high-corn diet in the finishing period. There was no effect (P > 0.25) of diet or genotype during either period on E. coli O157 shedding in feces. Forty-one percent of the steers were positive for Campylobacter spp. at least once during the study, and repeated isolations of Campylobacter spp. from the same steer were common. These repeated isolations from the same animals may be responsible for the apparent diet (P = 0.05) and genotype effects (P = 0.02) on Campylobacter in feces in the finishing period. Cells bearing stx genes were detected frequently in both feces (22.5%) and ruminal fluid (19.6%). The number of stx-positive fecal samples was greater (P < 0.05) for 1/2 Brahman steers (42.9%) than for 1/4 Brahman (25.0%) or 3/4 Brahman steers (22.2%), but were not different compared with MARC III steers (38.3%). The greater feed consumption of 1/2 Brahman and MARC III steers may have resulted in greater starch passage into the colon, accompanied by an increase in fecal bacterial populations, which may have further improved the ability to detect stx genes in these cattle. There was no correlation between either ADG or daily DMI and the number of positive samples of E. coli O157, Campylobacter spp., or stx genes, which agrees with our current understanding that these microorganisms occur commonly in, and with no measurable detriment to, healthy cattle.

Animal Feed↗

PubMed2006

Influence of genotype and diet on steer performance, manure odor, and carriage of pathogenic and other fecal bacteria. III. Odorous compound production.

Three beef cattle diets were assessed for their potential to produce odorous compounds from cattle feces excreted during the growing and finishing periods. Eight pens containing 51 steers of varying proportions of Brahman and MARC III genotypes were fed either a chopped bromegrass hay diet or a corn silage diet for a 119-d growing period. After the growing period, all steers were switched to the same high-corn finishing diet (high corn) and fed to a target weight of 560 kg (finishing period). Fecal slurries were prepared from a composite of fresh fecal pats collected in each pen during both periods and incubated anaerobically. In additional flasks, starch, protein, or cellulose was added to the composite fecal subsamples to determine the preferred substrates for fermentation and odorous compound production. The content and composition of the fermentation products varied both initially and during the incubation, depending on the diet fed to the steers. The corn silage and high corn feces had the greater initial content of VFA (381.0 and 524.4 micromol/g of DM, respectively) compared with the bromegrass feces (139.3 micromol/g of DM) and accumulated more VFA than the bromegrass feces during the incubation. l-Lactic acid and VFA accumulation in the high corn and corn silage feces was at the expense of starch, based on starch loss and the production of straight-chain VFA. In the bromegrass feces, accumulation of branched-chain VFA and aromatic compounds and the low starch availability indicated that the protein in the feces was the primary source for odorous compound production. Substrate additions confirmed these conclusions. We conclude that starch availability was the primary factor determining accumulation and composition of malodorous fermentation products, and when starch was unavailable, fecal microorganisms utilized protein.

Animal Feed↗

PubMed2005

Impact of dried skim milk in production diets on Lactobacillus and pathogenic bacterial shedding in growing-finishing swine.

AIMS: To determine the possible effects of inclusion of dried skim milk (DSM) in swine diets on indigenous Lactobacillus spp. and Escherichia coli, and its potential for controlling pathogen shedding and affect animal growth in growing-finishing swine. METHODS AND RESULTS: Animals were fed over three dietary phases to match production needs from age 10-14 weeks, 14-18 weeks and 18-22 weeks. For each feeding phase, diets were formulated to contain 0 or 10% DSM (balanced for metabolizable energy and true ileal digestible amino acids). Animals were weighed every 2 weeks and faecal samples were collected from 40 animals (20 with DSM and 20 without DSM) at week 10 (d 0 on diets), 14, 18 and 22 of age, and were analysed for Lactobacillus spp., Enterobacteriaceae, coliforms, E. coli, Salmonella, Campylobacter and E. coli O157:H7. At the start of the study (week 10), faecal bacterial counts (log10 CFU g(-1) faeces) were 9.55, 7.26, 7.01 and 6.93 for Lactobacillus, Enterobacteriaceae, coliforms and E. coli populations respectively. The Enterobacteriaceae, coliform and E. coli populations decreased through week 14 and 18, but were higher in animals fed with the DSM diet compared with the basal diet without DSM. The Lactobacillus populations at weeks 14 and 18 were lower in the animals fed the diet without DSM, whereas feeding DSM maintained the Lactobacillus counts from week 10. At week 22, populations of Enterobacteriaceae, coliforms and E. coli were >week 18 for the animals fed the diet without DSM, less change was observed with the feeding of DSM, and no differences between the diets were observed at week 22. However, in week 22 the animal gain was positively correlated with Lactobacillus numbers and negatively correlated with E. coli numbers. Subtraction of the E. coli population (log10) from the Lactobacillus population (log10) yielded a positive value termed 'effective'Lactobacillus that correlated well with animal gain and may better define a beneficial function in the intestine. Salmonella were detected in over 60% of the animals at week 10 and 14, and <20% at week 18 and 22. Campylobacter were detected rarely at weeks 10, 14 and 18, but were found in 25% of the animals at week 22. The DSM did not affect Salmonella or Campylobacter shedding, but examination of individual animals over the entire experiment indicated that fewer recurring incidences of Salmonella shedding occurred in animals that maintained higher Lactobacillus. In addition, at week 22, Salmonella and Campylobacter shedding was associated with lower levels of effective Lactobacillus and lower animal weight gains. CONCLUSIONS: The DSM did not directly affect the animal performance or pathogen shedding via the Lactobacillus spp. population at any phase of production. However, analysis of data from all animals revealed that faecal Lactobacillus affected Salmonella shedding and in the finishing phase, animal growth and pathogen shedding also were affected, as reflected by the 'effective'Lactobacillus-associated observations. SIGNIFICANCE AND IMPACT OF THE STUDY: In the swine intestine, any benefits from gastrointestinal Lactobacillus may be compromized by the E. coli population, and this antagonism may explain responses observed with prebiotics or probiotics in some swine.

Animal Feed↗

PubMed2005

Measurement error in computed tomography pelvimetry.

Computed tomography pelvimetry is still used in clinical practice. We wished to quantify observer error in order to assess the level of confidence with which pelvic measurements can be described as adequate or inadequate. Anteroposterior inlet, anteroposterior outlet, transverse inlet and interspinous distances were measured from 11 CT pelvimetry examinations by five observers at one institution. Three CT pelvimetries were measured by five observers at a second institution. Intraobserver and interobserver variation was assessed using analysis of variance. Reliability of measurements was assessed using intraclass correlation coefficient. Combined error was calculated to determine 95% confidence limits for published minimum recommended pelvic measurements. The standard error of measurement, combining all sources, for measurement of the bony dimensions of the pelvis were: for anteroposterior inlet, 2.0 mm; anteroposterior outlet, 6.9 mm; transverse inlet, 1.3 mm; and interspinous distance, 2.1 mm. The 95% confidence interval around the recommended anteroposterior outlet of 100 mm was 88.5-111.3 mm. Observer variation in measurement of anteroposterior outlet is so large as to make the measurement of doubtful clinical utility.

Analysis of Variance↗

PubMed2005

Effects of common forage phenolic acids on Escherichia coli O157:H7 viability in bovine feces.

Ruminant animals are carriers of Escherichia coli O157:H7, and the transmission of E. coli O157:H7 from cattle to the environment and to humans is a concern. It is unclear if diet can influence the survivability of E. coli O157:H7 in the gastrointestinal system or in feces in the environment. Feces from cattle fed bromegrass hay or corn silage diets were inoculated with E. coli O157:H7, and the survival of this pathogen was analyzed. When animals consumed bromegrass hay for <1 month, viable E. coli O157:H7 was not recovered after 28 days postinoculation, but when animals consumed the diet for >1 month, E. coli O157:H7 cells were recovered for >120 days. Viable E. coli O157:H7 cells in feces from animals fed corn silage were detected until day 45 and differed little with the time on the diet. To determine if forage phenolic acids affected the viability of E. coli O157:H7, feces from animals fed corn silage or cracked corn were amended with common forage phenolic acids. When 0.5% trans-cinnamic acid or 0.5% para-coumaric acid was added to feces from silage-fed animals, the E. coli O157:H7 death rate was increased significantly (17-fold and 23-fold, respectively) compared to that with no addition. In feces from animals fed cracked corn, E. coli O157:H7 death rates were increased significantly with the addition of 0.1% and 0.5% trans-cinnamic acid (7- and 13-fold), 0.1% and 0.5% p-coumaric acid (3- and 8-fold), and 0.5% ferulic acid (3-fold). These data suggest that phenolic acids common to forage plants can decrease viable counts of E. coli O157:H7 shed in feces.

Animal Feed↗

PubMed2004

Dried skim milk as a replacement for soybean meal in growing-finishing diets: effects on growth performance, apparent total-tract nitrogen digestibility, urinary and fecal nitrogen excretion, and carcass traits in pigs.

Two trials were conducted to determine the replacement nutritive value of dried skim milk for growing-finishing pigs. In a three-phase feeding trial, 180 growing composite barrows (40.8 +/- 2.9 kg BW) were allotted to three dietary treatments. Each phase lasted 28 d. Treatment 1 comprised a basal corn-soybean meal diet supplemented with crystalline AA to contain true ileal digestible concentrations (as-fed basis) of 0.83, 0.66, and 0.52% Lys; 0.53, 0.45, and 0.40% Thr; and 0.51, 0.45, and 0.42% sulfur amino acids (SAA; Met + Cys) in Phases 1, 2, and 3, respectively. Treatments 2 and 3 were the basal diets with 5 and 10% (as-fed basis) dried skim milk added. The three diets at each phase were formulated to have the same quantities of DE, true ileal digestible Lys, Thr, Trp, SAA, Ca, and available P. Pigs were housed 10 per pen (six pens/treatment), allowed ad libitum access to feed, and slaughtered at 121.6 +/- 9.3 kg BW. No differences were detected between pigs fed the basal diet and the dried skim milk diets or between pigs fed the 5 and 10% dried skim milk diets, respectively, in 84-d ADG (P = 0.84 or P = 0.71), ADFI (P = 0.54 or P = 0.91), and G:F (P = 0.80 or P = 0.97), in hot carcass weight (P = 0.66 or P = 0.74), 45-min postmortem LM pH (P = 0.90 or P = 0.53), 10th-rib backfat thickness (P = 0.24 or P = 0.77), LM area (P = 0.13 or P = 0.63), weights of belly (P = 0.43 or P = 0.70), trimmed wholesale cuts (P = 0.18 to 0.85 or P = 0.06 to 0.53), and ham components (P = 0.25 to 0.98 or P = 0.32 to 0.63). In the N balance trial, four littermate pairs of finishing gilts (82.9 +/- 2.0 kg BW) were assigned within pair to the basal or the 10% dried skim milk (as-fed basis) finishing diet. Daily feed allowance was 2.6x maintenance DE requirement and was given in two equal meals. Total fecal collection from eight meals and a 96-h urine collection began on d 14 when gilts weighed 92.1 +/- 2.2 kg BW. No differences were found between dietary treatments in gilt's daily N intake (P = 0.33) and the daily output of urinary urea (P = 0.88), urinary N (P = 0.97), fecal N (P = 0.69), and total manure (P = 0.62), as well as apparent total-tract N digestibility (P = 0.84) and N retention (P = 0.84). It is concluded that growing-finishing pigs fed diets containing 10% dried skim milk would have growth performance, carcass traits, and N digestibility and use similar to those fed typical corn-soybean meal diets.

Animal Feed↗

PubMed2001

SmokeChange for changing smoking in pregnancy.

AIM: To measure the extent to which SmokeChange, a personalised intervene, enabled pregnant women to rede their exposure to tobacco smoke. METHODS: A cross-section of general medical practices was randomly selected. General Practitioners (GPs) were to register all pregnant women with the SmokeChange programme. Smoking women were contacted by a SmokeChange Educator, who visited them at home. The Educator worked with women and their families for up to twelve months in order to support cognitive, environmental and behavioural changes to smoking. RESULTS: GPs registered 1,390 pregnant women. Current smoking, was reported by 437 (31.4%) and 209 (47.8% of smokers) chose to enrol with the SmokeChange intervention programme. of these, 149 women (34.1% of smokers) continued with the programme for at least four visits. From this 'long' participation group, 28 (18.8%) had stopped smoking entirely by their last visit in pregnancy. Another 26 (17.4%) reported at least one cessation attempt, together with a reduction of smoking consumption by 63% at the end of pregnancy. The 95 (63.8%) continued smokers had reduced their smoking consumption by 40%. Substantial smokefree environment (homes and cars) changes were also made. CONCLUSIONS: The SmokeChange approach of personalised intervention, matched to individual readiness for change, was both acceptable to pregnant women and enabled participants to substantially reduce tobacco toxin exposure to themselves and their developing infants.

Family Practice↗

PubMed2000

GABAergic inhibition suppresses paroxysmal network activity in the neonatal rodent hippocampus and neocortex.

In the adult cerebral cortex, the neurotransmitter GABA is strongly inhibitory, as it profoundly decreases neuronal excitability and suppresses the network propensity for synchronous activity. When fast, GABA(A) receptor (GABA(A)R)-mediated neurotransmission is blocked in the mature cortex, neuronal firing is synchronized via recurrent excitatory (glutamatergic) synaptic connections, generating population discharges manifested extracellularly as spontaneous paroxysmal field potentials (sPFPs). This epileptogenic effect of GABA(A)R antagonists has rarely been observed in the neonatal cortex, and indeed, GABA in the neonate has been proposed to have an excitatory, rather than inhibitory, action. In contrast, we show here that when fast GABAergic neurotransmission was blocked in slices of neonatal mouse and rat hippocampus and neocortex, sPFPs occurred in nearly half the slices from postnatal day 4 (P4) to P7 neocortex and in most slices from P2 to P7 hippocampus. In Mg(2+)-free solution, GABA(A)R antagonists elicited sPFPs in nearly all slices of P2 and older neocortex and P0 and older hippocampus. Mg(2+)-free solution alone induced spontaneous events in the majority of P2 and older slices from both regions; addition of GABA(A)R antagonists caused a dramatic increase in the mean amplitude, but not frequency, of these events in the hippocampus and in their mean frequency, but not amplitude, in the neocortex. In the hippocampus, GABA(A)R agonists suppressed amplitudes, but not frequency, of sPFPs, whereas glutamate antagonists suppressed frequency but not amplitudes. We conclude that neonatal rodent cerebral cortex possesses glutamatergic circuits capable of generating synchronous network activity and that, as in the adult, tonic GABA(A)R-mediated inhibition prevents this activity from becoming paroxysmal.

Action Potentials↗

PubMed2000

Isolation and characterization of cholic acid 7alpha-dehydroxylating fecal bacteria from cholesterol gallstone patients.

BACKGROUND/AIMS: The development of cholesterol gallstones, in some patients, has been associated with increased proportions of deoxycholic acid in the bile acid pool. Deoxycholic acid is a microbial product of cholic acid 7alpha-dehydroxylation in the intestines. The levels and activities of bile acid 7alpha-dehydroxylating bacteria have been reported to be increased in gallstone patients. The aim of the current study was to isolate 7alpha-dehydroxylating bacteria from gallstone patients and determine if these individuals are colonized by similar bacterial species. METHODS: The levels of 7alpha-dehydroxylating bacteria in fecal samples were determined by fecal dilutions in 24 gallstone patients and 10 controls. 7alpha-Dehydroxylating bacteria were isolated by a non-selective streak plate technique and 7alpha-dehydroxylation activity was determined by measuring the conversion of [14C]-cholic acid to [14C]-deoxycholic acid using thin-layer chromatography. RESULTS: Gallstone patients had >42-fold (p<0.01) higher levels of 7alpha-dehydroxylating bacteria than patients who had not developed gallstones. Eighteen strains of 7alpha-dehydroxylating bacteria were isolated from eight gallstone patients. Attempts to isolate 7alpha-dehydroxylating bacteria from ten control patients were unsuccessful using identical isolation techniques. Surprisingly, all strains of bacteria isolated from gallstone patients appear to belong to the genus Clostridium. CONCLUSION: Gallstone patients have higher levels of 7alpha-dehydroxylating fecal bacteria and appear to harbor only members of the genus Clostridium with this activity.

Adult↗

PubMed2000

Outcome of primary vesicoureteric reflux detected following fetal renal pelvic dilatation.

OBJECTIVE: Postnatal investigation of mild degrees of fetal hydronephrosis has allowed subsequent detection of infants with vesicoureteric reflux (VUR). This study was designed to provide short to medium term information on such infants who had primary VUR, the rates of renal damage and progression over time, the risk factors for such damage and to compare the characteristics of those who had mild dilatation of the fetal renal pelvis (4-9 mm) with those who had moderate-severe dilatation (> or = 10 mm). METHODOLOGY: Since June 1989, infants whose antenatal sonography had identified a fetal renal pelvis with an anteroposterior diameter of > 4 mm were investigated postnatally with renal ultrasonography and micturating cystourethrogram (MCU), and placed on antimicrobial prophylaxis. Those with VUR received 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. Infants were followed until discharge based on resolution of VUR, surgery, or low grade VUR. A 5.5 year cohort between June 1989 and December 1994 formed the study population. A review of notes and clinical review (if still under follow up) was undertaken. Vesicoureteric reflux on MCU was regraded according to the International Classification, and reflux nephropathy on DMSA scans was regraded according to criteria proposed by Goldraich. Regression analysis was used to assess risk factors for renal damage. RESULTS: There were 69 infants (37 girls, 32 boys) who were identified with primary VUR, with 37/69 having bilateral reflux. Eight had a urinary tract infection during the follow-up period. There was a broad distribution of grades of reflux detected (Grades I-3, Grades II-23, Grades III-19, Grades IV - 17, Grades V-7). 99m-Tc-dimercaptosuccinic acid scans on 57/69 (83%) demonstrated renal damage in eight infants (14%). This was predominantly global contraction of function. No progression of renal damage was seen over 2-7 years. Regression analysis showed a strong association between Grades IV, V reflux and the presence of renal damage (P < 0.001). Review of the degrees of fetal renal pelvic dilatation showed that 60/69 infants were detected because of mild (4-9 mm) dilatation. The majority (43/60) had lower grades of reflux (Grades I, II, 3), but there was no obvious cut-off between 4 and 9 mm that could predict high grade VUR (Grades IV, V). CONCLUSIONS: The use of 4 mm to define an abnormal fetal renal pelvis allows a much larger group of infants with high grade primary VUR to be detected than if a higher cut-off measurement is used. Although it also detects many more infants with low grade primary VUR, there is no obvious cut-off point at which this effect predominates. Progressive renal damage was not seen in follow up of up to 7 years of age. Renal damage on DMSA scanning in this group is almost exclusively a pattern of global contraction of function. The presence of high-grade VUR appears to be the only important factor in predicting the presence of renal damage.

Child↗

PubMed2000

Identification and characterization of a bile acid 7alpha-dehydroxylation operon in Clostridium sp. strain TO-931, a highly active 7alpha-dehydroxylating strain isolated from human feces.

Clostridium sp. strain TO-931 can rapidly convert the primary bile acid cholic acid to a potentially toxic compound, deoxycholic acid. Mixed oligonucleotide probes were used to isolate a gene fragment encoding a putative bile acid transporter from Clostridium sp. strain TO-931. This DNA fragment had 60% nucleotide sequence identity to a known bile acid transporter gene from Eubacterium sp. strain VPI 12708, another bile acid-7alpha-dehydroxylating intestinal bacterium. The DNA (9.15 kb) surrounding the transporter gene was cloned from Clostridium sp. strain TO-931 and sequenced. Within this larger DNA fragment was a 7.9-kb region, containing six successive open reading frames (ORFs), that was encoded by a single 8.1-kb transcript, as determined by Northern blot analysis. The gene arrangement and DNA sequence of the Clostridium sp. strain TO-931 operon are similar to those of a Eubacterium sp. strain VPI 12708 bile acid-inducible operon containing nine ORFs. Several genes in the Eubacterium sp. strain VPI 12708 operon have been shown to encode products required for bile acid 7alpha-dehydroxylation. In Clostridium sp. strain TO-931, genes potentially encoding bile acid-coenzyme A (CoA) ligase, 3alpha-hydroxysteroid dehydrogenase, bile acid 7alpha-dehydratase, bile acid-CoA hydrolase, and a bile acid transporter were similar in size and exhibited amino acid homology to similar gene products from Eubacterium sp. strain VPI 12708 (encoded by baiB, baiA, baiE, baiF, and baiG, respectively). However, no genes similar to Eubacterium sp. strain VPI 12708 biaH or baiI were found in the Clostridium sp. strain TO-931 bai operon, and the two putative Eubacterium sp. strain VPI 12708 genes, baiC and baiD, were arranged in one continuous ORF in Clostridium sp. strain TO-931. Intergene regions showed no significant DNA sequence similarity, but primer extension analysis identified a region 115 bp upstream from the first ORF that exhibited 58% identity to a bai operator/promoter region identified in Eubacterium sp. strain VPI 12708. These results indicate that the gene organization, gene product amino acid sequences, and promoters of the bile acid-inducible operons of Clostridium sp. strain TO-931 and Eubacterium sp. strain VPI 12708 are highly conserved.

3-Hydroxysteroid Dehydrogenases↗

PubMed2000

Psychoses associated with thyrotoxicosis - 'thyrotoxic psychosis.' A report of 18 cases, with statistical analysis of incidence.

OBJECTIVE: To report a series of newly diagnosed thyrotoxic patients with concurrent acute psychosis, and to assess the association between the two disorders. DESIGN: Retrospective study of thyrotoxic patients with associated psychosis ('thyrotoxic psychosis'; TP) requiring inpatient psychiatric care. New Zealand thyrotoxicosis annual incidence figures and first psychiatric admission rates for affective psychosis were utilised to statistically assess the co-occurrence of thyrotoxicosis and affective psychosis. PATIENTS AND METHODS: During the 20-year study period, 18 inpatients (16 women and 2 men), mean age 54 years, with TP were identified. No patient had a past history of thyrotoxicosis, but four had required psychiatric inpatient care many years earlier. Thyrotoxicosis was documented by radioimmunoassay of thyroid hormone levels, and thyroid scintiscan. Psychiatric manifestations were classified using ICD9 criteria. RESULTS: Thyroid hormone levels were markedly elevated in more than half of our TP patients. All younger patients had Graves' disease, and most older patients toxic nodular goitre. All patients were treated with antithyroid drugs, and all but one subsequently received (131)I therapy. Two patients were not mentally ill when thyrotoxicosis was diagnosed, but suffered major mood swings when thyroid hormone levels were falling. There was no specific psychiatric clinical picture but affective psychoses were commonest - seven depression, seven mania. The other diagnoses were two schizophreniform, one paranoid, and one delirium. Initially, neuroleptic medication was used in all but one patient, and during long-term follow-up (median 11 years) more than half our series had remained well with no further psychiatric problems. Statistical analysis was restricted to thyrotoxic patients with first psychiatric hospital admission for affective psychosis. During the 20-year period, there were nine thyrotoxic patients (95% confidence interval 4.5-17.1) with concurrent affective psychosis requiring first admission, and the calculated expected number was only 0.36. These findings indicate a clear association well above chance co-occurrence. CONCLUSION: TP is not a specific clinical picture, but affective psychoses are commonest. Statistical analysis of thyrotoxic patients with concurrent affective psychoses showed an incidence well above chance co-occurrence. It appears that thyrotoxicosis may be a precipitant of acute affective psychosis.

Adult↗

PubMed1999

Cerebellar vermis diameter at cranial sonography for assessing gestational age in low-birth-weight infants.

BACKGROUND: Clinical assessment of gestational age for very-low-birth-weight infants is often inaccurate. Survival rates are more dependent on gestational age than on the birth weight. OBJECTIVE: To assess whether cerebellar vermis diameter might predict gestational age in infants under 2,000 g and/or under 32 weeks' gestation. MATERIALS AND METHODS: We carried out a retrospective review of the hard-copy images of midline sagittal views of the cerebellum obtained at cranial sonography, performed via the anterior or posterior fontanelle, in 518 infants admitted to a regional neonatal intensive care unit between June 1991 and November 1996. The vermis diameter was measured from the base of the fourth ventricle to the junction of folium and tuber vermis. We generated regression equations for estimating gestational age from vermis diameter, and from vermis diameter and birth weight, for the 86 infants of known gestational age (less than 32 weeks), with birth weight under 2,000 g and who had scans carried out within 1 week of birth. RESULTS: Measurement of cerebellar vermis diameter alone allowed prediction of gestational age to +/- 1.53 weeks using a 68 % prediction interval, or +/- 3.0 weeks using a 95 % prediction interval. Gender was not significant in the regression analysis. CONCLUSION: Cerebellar vermis diameter predicts gestational age with slightly more precision than the new Ballard score.

Birth Weight↗

PubMed1999

Prevalence of suicide ideation and suicide attempts in nine countries.

BACKGROUND: There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. METHODS: Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. RESULTS: The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. CONCLUSIONS: While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

Adolescent↗

PubMed1999

Predicting renal survival in primary focal glomerulosclerosis from the time of presentation.

UNLABELLED: Predicting renal survival in primary focal glomerulosclerosis from the time of presentation. BACKGROUND: To predict the risk of developing chronic renal failure in patients with primary focal glomerulosclerosis (FGS) using predictors available at the time of presentation, a retrospective analysis was performed on 111 patients who were diagnosed at Christchurch Hospital from 1965 to 1998. METHODS: The predictors of outcome included age, gender, systolic and diastolic blood pressure, serum albumin, plasma creatinine, presence of hematuria, and amount of proteinuria (all at the time of presentation). An injury score (combination of percentage of sclerosed glomeruli and proportion of tubulointerstitial fibrosis) was derived from a review of the initial kidney biopsy. Log-logistic accelerated failure time parametric models were used. RESULTS: The median renal survival was 16.4 years (Kaplan-Meier estimate). The best single variable model was that using the proportion of tubulointerstitial fibrosis (global chi-square 55.99, P < 0.0001). However, inclusion of plasma creatinine significantly improved the fit of the model (global chi-square 65.04, P < 0.0001). This joint model was superior to the single-variable model. Both of the models were validated using jackknifing. CONCLUSION: For a patient with primary FGS, these models can be used to predict the risk of developing chronic renal failure at any time and the median renal survival, given the proportion of tubulointerstitial fibrosis and plasma creatinine at the time of presentation.

Adolescent↗

PubMed1999

The bile acid-inducible baiF gene from Eubacterium sp. strain VPI 12708 encodes a bile acid-coenzyme A hydrolase.

The human intestinal Eubacterium sp. strain VPI 12708 has been shown to have a multistep biochemical pathway for bile acid 7alpha-dehydroxylation. A bile acid-inducible operon encoding 9 open reading frames has been cloned and sequenced from this organism. Several of the genes in this operon have been shown to catalyze specific reactions in the 7alpha-dehydroxylation pathway. The baiF gene from this operon was cloned, expressed in Escherichia coli, and found to encode a novel bile acid-coenzyme A (CoA) hydrolase. The subunit molecular mass of the purified bile acid-CoA hydrolase was calculated to be 47,466 daltons and the native enzyme had a relative molecular weight of 72,000. The K m and Vmax for cholyl-coenzyme A (CoA) hydrolysis was approximately 175 microm and 374 micromol/min per mg protein, respectively. The enzyme used cholyl-CoA, 3-dehydrocholyl-CoA, and chenodeoxycholyl-CoA as substrates. No hydrolytic activity was detected using acetyl-CoA, isovaleryl-CoA, palmitoyl-CoA, or phenylacetyl-CoA as substrates. Amino acid sequence database searches showed no significant similarity of bile acid-CoA hydrolase to other thioesterases, but significant amino acid sequence identity was found with Escherichia coli carnitine dehydratase. The characteristic thioesterase active site Gly-X-Ser-X-Gly motif was not found in the amino acid sequence of this enzyme. Bile acid-CoA hydrolase from Eubacterium sp. strain VPI 12708 may represent a new family of thioesterases.

Acyltransferases↗

PubMed1998

A population-based study of bone mineral density in women with longstanding type 1 (insulin dependent) diabetes.

This study aimed to explore multiple determinants of BMD (bone mineral density) in 99 women with long-standing type 1 diabetes, recruited from a population based register of insulin users. BMD was measured using DEXA (dual energy X-ray absorptiometry) at the femoral neck and lumbar spine, age adjusted Z scores were calculated and results compared to those of healthy volunteers. The median age of diabetic subjects was 42 years and the median duration of diabetes was 27 years. BMD was positively associated with body mass index and height at both the lumbar spine and femoral neck. There was a positive association with oral contraceptive pill use and lumbar spine BMD, and peripheral vascular disease was negatively associated with femoral neck BMD. No correlation was seen with either age or duration of diabetes and absolute BMD values. Mean Z score at the femoral neck was -0.12 (95% confidence interval -0.37 to +0.12). At the lumbar spine, the corresponding value was -0.21 (-0.44 to +0.02). Pre- and post-menopausal values for the diabetic subjects and healthy volunteers were found to be similar. In summary, axial BMD values in subjects with long-standing diabetes were similar to those observed in healthy non diabetic populations.

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