Use of pre- and post-test probability of disease to interpret meningococcal PCR results.
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Adolescent↗
Biomedical subjects
M Thomas
Publications and source records attributed to M Thomas.
What women want: women's preferences of caregiver behavior when prenatal sonography findings are abnormal.
OBJECTIVE: To determine what women value when receiving news of a pregnancy abnormality detected by ultrasound. METHODS: Women who had a pregnancy complication detected sonographically in the year 2000 were asked to complete a survey of 21 questions measuring the importance of various factors related to the receipt of bad news. Of the target sample of 117 women who agreed to participate, 76 (64.9%) returned completed surveys. Cases included serious anomalies (67%) and soft markers/obstetric complications (33%). RESULTS: Responses to questions on 'information quality', 'prompt provision of information', 'information-provider behavior' and 'information provision environment' showed that women attached the most importance to information quality, much more so than to promptness. Speed was even less important than information-provider empathy. Answers concerning use of the terms 'fetus' or 'baby' revealed greater variation in preferences than any other. Privacy was the most important environmental variable, more important than some information quality variables, or any promptness variable. Intervening variables considered included demographic variables and the seriousness of the prognosis. Education was the most useful predictor of preferences, with highly educated women generally placing less value on environment and some information quality variables, and having different preferences concerning the terms 'fetus' and 'baby'. CONCLUSIONS: Our findings shed some light on what is important to women who face bad news. Although more research is needed in this important area, we hope that our findings may assist institutions and caregivers in establishing guidelines for the effective and considerate communication of bad news.
Caregivers↗
[Cellular changes in non-small cell lung cancer after neoadjuvant therapy].
Microscopic analysis of resection specimens of non-small cell lung cancer after neoadjuvant therapy evokes the subjective impression of cytologic changes, especially enlargement of the individual tumor cells and their nuclei. Therefore, objectivization of these changes was tested morphometrically. Corresponding investigations could be carried out in 24 patients who had each received identical neoadjuvant therapy. The diameters and areas of the tumor cells and their nuclei as well as the nucleocytoplasmic ratio were assessed. The adenocarcinomas investigated revealed a significant cellular enlargement after treatment. Moreover, in 18 resection specimens (75%), cytomorphological changes could be shown in comparison to untreated tumor tissue. The cellular and nuclear parameters analysed as well as the cytomorphological changes assessed showed no significant correlation to the grade of therapy-induced tumor regression and thus do not allow an assessment of therapy success. Based on these results, grading of non-small cell lung cancer is not recommended after neoadjuvant therapy and the diagnosis of "large cell anaplastic" carcinoma should be made with reservation.
Adenocarcinoma↗
Effects of transforming growth factor-beta on aggrecanase production and proteoglycan degradation by human chondrocytes in vitro.
OBJECTIVE: Aggrecan is degraded by Aggrecanases (ADAMTS-4 and -5) and MMPs, which cleave its core protein at different sites. Transforming growth factor (TGF)beta is known to stimulate matrix formation in cartilage, and ADAMTS-4 production in synoviocytes. The aim of this in-vitro study was to examine the effects of TGFbeta on aggrecanase production in human cartilage. DESIGN: Expression of ADAMTS-4 and -5 in chondrocyte cultures from normal or osteoarthritic cartilage was studied at mRNA level by RT-PCR. Aggrecanase activity was examined by western blot of aggrecanase-generated neoepitope NITEGE, and by measure of proteoglycan degradation in cartilage explants. RESULTS: TGFbeta strongly increased mRNA levels of ADAMTS-4, while ADAMTS-5 was expressed in a constitutive way in chondrocytes from normal and osteoathritic cartilage. TGFbeta also increased NITEGE levels and proteoglycan degradation. Addition of an aggrecanase inhibitor blocked the increase of NITEGE, and partially inhibited proteoglycan degradation. CONCLUSIONS: TGFbeta stimulates ADAMTS-4 expression and aggrecan degradation in cartilage. This catabolic action seems to be partially mediated by aggrecanases. It is, therefore, proposed that the role of TGFbeta in cartilage matrix turnover is not limited to anabolic and anti-catabolic actions, but also extends to selective degradation of matrix components such as aggrecan.
ADAM Proteins↗
Breast cancer incidence and its possible spatial association with pesticide application in two counties of England.
BACKGROUND: This study examines the spatial distribution of breast cancer incidence in Lincolnshire and Leicestershire, and its association with the application of selected pesticides. METHODS: The Black-White (BW) join-count statistic and Moran I coefficient were used to investigate the localized distribution of breast cancer. Linear regression techniques were applied to examine the association between the breast cancer incidence rate and pesticide application. RESULTS: The results from the BW join-count test and the Moran I coefficient test showed no overall evidence of localized distribution, 'clusters', of breast cancer. The regression analyses showed no sign of spatial association between breast cancer and application of pesticides in the urban areas as expected. The findings, however, did reveal a spatial association between the breast cancer incidence rates and the application of three selected pesticides [Aldicarb, Atrazine and Lindane (thought to potentially mimic oestrogen)] in rural Leicestershire. No such association was seen in Lincolnshire. CONCLUSIONS: Pesticides vary significantly in their spatial application. Overall, consistent associations between breast cancer incidence rates and the selected pesticides were not found, although the ecological study design has limitations and these are discussed. This approach is able to rule out strong associations; assessment of smaller risk would require a large and expensive study in individuals. The results of this study, although derived in the UK, have significance to the debate concerning the possibility of environmental compounds that mimic oestrogen and their consequences for human health.
Aged↗
[Micronutrients status of Ile-de-France inhabitants. A literature review].
PURPOSE: A review of the literature about micronutrients status of Ile-de-France inhabitants. CURRENT KNOWLEDGE AND KEY POINTS: During the last decades, substantial changes in the French diet had an impact on micronutrients intake. Over this time, several studies conducted in Ile-de-France showed that a large part of its inhabitants is subject to an increased risk of mild to severe deficiency in one or more micronutrient(s). Teenagers and subjects over 70 years-old are groups at risk for vitamin D deficiency. During the 1980s, iron intake was insufficient in a majority of menstruating women and iron deficiency was common during pregnancy. Vitamin C deficiency is constantly present in homeless people and often associated with an insufficient intake in a number of micronutrients. FUTURE PROSPECTS AND PROJECTS: Identification of the groups at risk favours a better adequacy of preventive action on micronutrient deficiencies in this population. However, the efficacy of prevention is to be determined. Controlled trials of micronutrients' supplementation may be useful to value the beneficial effects of micronutrient supplementation on the incidence of cardiovascular diseases and cancer.
Adolescent↗
Biological significance of DNA adducts: summary of discussion of expert panel.
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Animals↗
Aerial measurements of artificial radionuclides in Germany in case of a nuclear accident.
Gamma-ray spectrometric systems carried by helicopters prove to be indispensable for the surveillance of environmental radioactivity. The aerial measurements are an important tool for rapid and large-scale nuclide specific determination of soil contamination after an accidental release of radionuclides from a nuclear facility. Furthermore this technique is also applied for the determination of anomalies of elevated radioactivity of natural radionuclides, the detection of lost radioactive sources and geological mapping. For the measurements the helicopters are equipped with a NaI(Tl)-detector array and a high purity germanium-semiconductor (HPGe) detector. Especially with the HPGe-detector it is possible to clearly identify individual radionuclides. To improve and to guarantee the quality of this method several exercises with different fields of interest have been carried out during the last years. Thereby the main focus is on the improvement of the instrumentation, data handling and data analysis. The results of the airborne radionuclide measurements from the Black Forest which was performed in co-operation with the Swiss National Emergency Operation Centre, are presented here. During this exercise the gamma dose rate, soil contamination due to 137Cs and the specific activities of natural radionuclides in soil were determined.
Aircraft↗
Contribution of biomechanics, orthopaedics and rehabilitation: the past present and future.
Biomechanics is a field that has a very long history. From its beginnings in ancient Chinese and Greek literature, the field of orthopaedic biomechanics has grown in the areas of biomechanics of bone, articular cartilage, soft tissues, upper extremities, spine and so on. Bioengineers in collaboration with orthopaedic surgeons have applied biomechanical principles to study clinically relevant problems, improving patient treatment and outcome. In the past 30 years, my colleagues and I have focused our research on the biomechanics of musculoskeletal soft tissues, ligaments and tendons in particular. Therefore, in this review article, the function of the knee ligaments and the associated homeostatic responses secondary to immobilisation and exercise will be described. Research on healing of the medial collateral ligament (MCL) of the knee and possible future approaches in improving the healing of the knee ligaments will be presented. Finally, improvement of the understanding of ligament reconstruction, specifically of the anterior cruciate ligament (ACL), through the use of robotics technology will be included. Throughout the manuscript, specific scientific findings that have guided or changed the clinical management of injury to these soft tissues will be emphasised.
Anterior Cruciate Ligament↗
Human normal hepatocytes are susceptible to apoptosis signal mediated by both TRAIL-R1 and TRAIL-R2.
Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) triggers apoptosis in tumor cells without toxicity to normal cells, but some recombinant versions of TRAIL caused hepatocyte death. We generated fully human monoclonal antibodies (mAbs) that bind specifically to TRAIL receptor 1 (TRAIL-R1) and TRAIL receptor 2 (TRAIL-R2), which mediate apoptosis signal when they ligate with TRAIL, to investigate the contribution of each receptor to induce tumor cell apoptosis and hepatocyte toxicity. All of mAbs to TRAIL-R1 and TRAIL-R2 induced cell death in several cancer cell lines susceptible to TRAIL but not in human umbilical vein endothelial cells in vitro. Both anti-TRAIL-R1 mAbs and anti-TRAIL-R2mAbs also caused cell death in hepatocytes. However, a subset of mAbs to TRAIL-R2, which was characterized by the TRAIL blocking activity, did not show strong hepatocyte toxicity. These results indicate that human normal hepatocytes are susceptible to both TRAIL-R1- and TRAIL-R2-mediated apoptosis signal. Cell Death and Differentiation (2004) 11, 203-207. doi:10.1038/sj.cdd.4401331 Published online 24 October 2003
Animals↗
Electrogastrographic biofeedback: a technique for enhancing normal gastric activity.
Biofeedback has been used effectively for approximately 40 years as a technique to help individuals learn to control muscle activity, brain waves, certain autonomic nervous system responses such as heart rate and blood pressure, and, more recently, constipation and fecal and urinary incontinence. In the present study, biofeedback of electrogastrographic (EGG) activity was used to determine the extent to which healthy subjects could increase normal 3 cpm gastric myoelectric activity. Thirteen experimental participants were provided with biofeedback of their EGG activity on a computer screen, and instructed to try to make their own EGG signal match a simulated 3 cpm signal that was also present on the screen. Subjects were told to relax using various forms of imagery, and to heighten their awareness of their stomach activity. Thirteen control participants did not receive any biofeedback but were otherwise given the same instructions. Both groups showed an increase in 3 cpm activity while relaxing. However, over four trials separated by 2-7 days, experimental participants showed an increased percentage of 3 cpm activity during biofeedback sessions, while control participants showed a decrease in 3 cpm activity during the corresponding sessions. In conclusion, we have demonstrated that healthy subjects can increase their normal gastric 3 cpm activity with the use of EGG biofeedback.
Adolescent↗
Short course intravenous benzylpenicillin treatment of adults with meningococcal disease.
BACKGROUND: Short-course treatment of meningococcal disease (including meningitis) with 4-5 days of an i.v. beta-lactam is of proven efficacy. Since April 1998, all adult patients with meningococcal disease admitted to Auckland Hospital were prospectively treated with 3 days of i.v. benzylpenicillin. AIMS: To assess the clinical features, laboratory findings, disease complications and outcome of patients with meningococcal disease prospectively treated with 3 days of i.v. benzylpenicillin. METHODS: A retrospective chart review of all adult patients with meningococcal disease admitted to Auckland Hospital from April 1998 to December 2002 was conducted. RESULTS: Ninety patients with definite (n = 72) or -probable (n = 16) meningococcal disease were admitted during the study period. Two were excluded on the basis of treatment duration. The remaining 88 patients received a mean +/- standard deviation duration of treatment of 3.1 +/- 0.5 days (excluding those who died while receiving treatment). Six patients (7%) died, four of whom while on treatment. There were no relapses. CONCLUSION: Three days of i.v. benzylpenicillin for the treatment of adults with meningococcal disease is effective.
Adult↗
Patient and direct-care staff body mass index in a state mental hospital: implications for management.
OBJECTIVE: Obesity is a major problem among chronically psychotic patients. METHOD: We assessed body mass index (BMI) of chronically psychotic patients on admission to a state mental hospital and in follow-up. We also compared patient BMI to staff BMI. RESULTS: The initial patient BMI (26.4 +/- 5.8 kg/m2) was in the overweight range. The patient BMI (29.1 +/- 5.8 kg/m2) increased (P < 0.0001) on follow-up and almost reached the level of obesity. Staff BMI (35.1 +/- 8.6 kg/m2) was in the obese range with 64.9% meeting criteria of obesity and 29.9% meeting criteria of morbid obesity. African-American women made up 84.5% of clinical-care staff and constitute the race-sex mix most vulnerable to obesity in the US. Morbid obesity (BMI > or = 40 kg/m2) was five times more common among these African-American female clinical-care staff than among African-American women in the general US population. CONCLUSION: Our findings may have treatment implications for chronically psychotic patients at risk for obesity.
Adult↗
Sequential photodynamic therapy (PDT) and high dose brachytherapy for endobronchial tumour control in patients with limited bronchogenic carcinoma.
BACKGROUND: Bulky endobronchial tumours in patients with lung cancer are difficult to treat. Brachytherapy and photodynamic therapy (PDT) are variably effective, and the combination of these treatments is not often recommended. However, cell culture studies and animal studies indicate a possible synergistic effect of combining PDT with ionising radiation. We assessed the safety and effectiveness of combined brachytherapy and PDT in patients with bulky endobronchial lung cancer. METHODS: Patients with histologically proven non-small cell bronchogenic carcinoma and bulky endobronchial tumours were treated using a combination of PDT (Photofrin, 2 mg/kg) and brachytherapy. Six weeks after PDT, brachytherapy was applied with five fractions of 4 Gy at weekly intervals. Follow up was performed with standard and autofluorescence bronchoscopy and tissue biopsies every 3 months. RESULTS: Thirty two patients were treated. Tumours were extensive with lengths ranging from 10 to 60 mm along the bronchus and estimated volumes ranging from 40 to 3500 mm3. At a mean follow up of 24 months, 26 patients were free of residual tumour and local recurrence. The remaining patients received a second treatment with PDT, brachytherapy, Nd:YAG laser coagulation, or external beam radiation. Distant metastases (lung, lymph node) developed in two of the six patients. Currently, all 32 patients are well. There is no evidence of residual or local recurrent endobronchial cancer in 28 patients and none had severe complications. CONCLUSION: The combination of PDT and brachytherapy for treating patients with lung cancer and extensive endobronchial tumour is safe and, in this study, had excellent therapeutic efficacy.
Aged↗
Implementation of a spreadsheet program for calculation of equivalent square field size.
Equivalent square field size is a parameter widely used in calculations for external beam treatment planning. The algorithm and features of a spreadsheet program used to calculate the equivalent square, independently of the treatment planning system, are described. The program uses an approximation method based on the application of Lamé curves. Comparison of the output, for a variety of field shapes and sizes, with tabulated data and other calculation methods yielded differences typically </=1 mm.
Algorithms↗
Barriers to childhood immunization: findings from a needs assessment study.
This study examines the current status of immunization among 0-3 year old children in Bakersfield and identifies barriers that prevent families from immunizing their children. A survey research design using a stratified sampling method was employed to collect data from 207 randomly selected English and Spanish speaking households having at least one child between the ages of 0-3 in Bakersfield. The findings reveal that 49% of the parents had no shot cards regarding children's immunization status. However, a significant majority of them immunized their children despite having no records. The most commonly reported consumer related barrier for late immunization was having a sick child followed by lack of parental memory and fear of side effects. The major provider-related barriers included lack of an opening for an appointment with the health care provider, limited clinic hours, and long lines in clinics. Lack of transportation was the single most systemic barrier. These findings suggest that reminder calls, increased transportation, weekend clinics and better rapport with parents can improve the immunization rates in ethnically diverse rural communities.
Adult↗
Prevalence and demographic features of childhood growth hormone deficiency in Belgium during the period 1986-2001.
OBJECTIVE: Since the availability of recombinant human growth hormone (rhGH) all children with growth hormone deficiency (GHD) living in Belgium are offered rhGH treatment after approval by a peer-review board. In this study, we evaluated the prevalence and demographic features of childhood GHD in Belgium during the period 1986-2001 and we compared them with the data from other countries. METHODS: Diagnostic, demographic and baseline auxological data of 714 children diagnosed as having GHD between 1986 and 2001 were retrieved from the database of the Belgian Study Group for Paediatric Endocrinology. RESULTS: The prevalence of GHD in Belgium was estimated to be 1/5600. The origin of GHD was idiopathic (idGHD) in 41% of the patients, congenital (congGHD) in 20% and acquired (acqGHD) in 35%. During the first 4 years (1986-1989) more patients were classified as idGHD; thereafter the distribution between the three aetiology groups did not change. In all groups, boys outnumbered girls but this preponderance was especially pronounced in congGHD patients (male:female=4:1) with a central malformation that associates an anterior pituitary hypoplasia, a missing, fine or normal pituitary stalk and an ectopic posterior pituitary. Thirteen percent of the patients with idGHD, 50% with congGHD and 52% with acqGHD had multiple pituitary deficiencies. Patients with congGHD were the youngest (mean+/-s.d. age: 6.5+/-4.7 years) and were the shortest (-3.0+/-1.3 standard deviation score (SDS)) at the start of rhGH treatment. There was no time trend over the studied period for age and height at onset of GH therapy. CONCLUSION: In Belgium, the prevalence of childhood GHD can be estimated as 1/5600 which is comparable to other recent surveys. The yearly number of new patients for the different aetiologies and the auxological parameters have remained relatively constant over the last 16 years.
Adolescent↗
Alteration in uterine contractility in mares with experimentally induced placentitis.
An experimental model of ascending placentitis was developed in the mare to characterize the uterine myoelectrical pattern in late gestation and determine how ascending placentitis altered this pattern. In experiment 1, myometrial electrical activity was analyzed during the early morning, late morning and evening hours in four mares in the last 15 days of gestation to identify patterns of activity. In experiment 2, nine mares received intra-cervical inoculations of Streptococcus equi subspecies zooepidemicus. Myoelectrical activity in the early morning and evening hours in these mares was compared with four control mares. In experiment 1, the number of spike burst clusters >30 s was greater in the evening than in the late morning hours (P < 0.04). Spike burst activity (number x duration) of mares in experiment 1 was similar during day and night recordings until the last 6 days of gestation when it gradually increased each evening until parturition (P < 0.05). In experiment 2, control mares experienced a gradual increase in the number of small spike burst clusters in the last 6 days (P = 0.008) and an increase in large and small spike burst clusters in the evening hours in the last 4 days of gestation (P = 0.03). Mares with experimentally induced placentitis never exhibited a rise in spike burst clusters but had an increase in the mean duration and activity index of large spike burst clusters in the 4 days before parturition (P < 0.04). In conclusion, control mares had a progressive, reversible rise in myoelectrical activity at night in the week preceding parturition. This was not observed in mares with experimentally induced placentitis. They exhibited an increase in the intensity and duration of large spike burst clusters possibly in response to local inflammation.
Animals↗