The association of celiac disease, diabetes mellitus type 1, hypothyroidism, chronic liver disease, and selective IgA deficiency.
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Adolescent↗
Biomedical subjects
P Brosnan
Publications and source records attributed to P Brosnan.
Osteopenia in young adult survivors of childhood cancer.
BACKGROUND: Improved survival of children with malignant diseases is in part due to the application of intensive, multimodality therapies, including radiotherapy, surgery, glucocorticoids, and cytotoxic agents. Such interventions have the potential to induce complex hormonal, metabolic and nutritional effects that may interfere with skeletal mass acquisition during childhood and adolescence: it is possible that such childhood cancer survivors may therefore reach adulthood with diminished peak bone mass and be at increased risk for clinically significant osteoporosis later in their life. PROCEDURE: A bone mineral density (BMD) was measured in 26 unselected former cancer patients attending the Pediatric Long-Term Clinic at M.D. Anderson Cancer Center. BMD was measured at the lumbar spine and the hip using dual X-ray absorptiometry (Hologic QDR-4500W). In addition, the patients' complete medical records were reviewed with particular attention to disease type, age modalities of treatment, and hormonal residual deficiencies. RESULTS: The median age of patients at the time of cancer diagnosis was 8 years (range, 0.3 to 16 years). Median age at BMD determination was 23 years (range, 18 to 41 years), and the median interval since cancer diagnosis and BMD was 18 years (range, 5 to 29). Overall, their BMD was decreased relative to peak bone mass at all sites: osteopenia was especially pronounced in patients with a history of cranial irradiation who had developed evidence of pituitary insufficiency during childhood or adolescence. Overall, the median BMD T-score was -1.41 at the lumbar spine, -1.04 at the femoral neck, and -1.06 for total hip. For patients with prior cranial irradiation, T-score at the lumbar spine was -2.18 (range, -4.06 to -0.98), at the femoral neck -1.92 (range, -4.11 to +1.10), and for total hip -1.67 (range, -4.79 to +0.56); BMD for irradiated patients was significantly lower than BMD of patients without cranial irradiation. We could not discern an independent impact of other disease characteristics or treatment modalities in this small group of patients. CONCLUSIONS: Osteopenia is a prominent finding in young adults who are survivors of childhood cancers; it is likely that antineoplastic treatments during childhood and adolescence impede peak bone mass acquisition. We suggest that systematic attention to this potential complication is needed in order to identify what subgroups of children may require regular surveillance and what interventions are required for its prevention or treatment.
Adolescent↗
Knowledge based lipid management system for general practitioners.
The aim of this system is to provide computer generated interpretative reports with management advice for General Practitioners (GPs). The lipid domain was chosen because of its importance in preventive medicine. Request forms to elicit extra clinical information were designed and distributed to a group of randomly selected GPs. Interpretation of laboratory and clinical data categorizes patients according to risk of coronary heart disease. The management system is rule based and provides advice on lifestyle modifications, diet and drug intervention. Previous clinical and laboratory results are taken into account in determining a management strategy. To date 435 request forms have been processed: 309 (71%) from first visits and 126 (29%) from follow-up visits. Normal lipid profiles were found in 19% of cases. There was 93% agreement between management advice given by the system and the expert. The system has now been modified and further evaluation is under way.
Artificial Intelligence↗
Clinical utility of an international thyroid database.
Assessment of thyroid function is prone to errors from several sources. Confusion is most often due to inappropriate use of tests, especially in patients with acute non-thyroid illness. With these problems in mind we have designed an international prospective thyroid database in three countries, which registers clinical and laboratory data on new patients with suspected thyroid disease. An additional aim was to assess the use of a computerised decision support tool to interpret thyroid data. The database permits rapid access to temporal trends in thyroid tests, which is useful in monitoring therapy and in follow up for hyperthyroidism. Marked contrasts in local clinical practices have highlighted the challenge in providing a valid decision tool to serve all clinical needs. Experience with multi-centre databases such as this hold promise in the drive to coordinate the disciplines of laboratory analysis and clinical decision making.
Clinical Laboratory Information Systems↗
Identification of new markers in Xp21 between DXS28 (C7) and DMD.
Characterization of Xp21 distal to Duchenne muscular dystrophy (DMD) in the region containing the genes for adrenal hypoplasia congenita (AHC) and glycerol kinase deficiency (GKD) has been limited due to a paucity of probes. Two probes were localized between DXS28 (C7) and AHC, the yeast artificial chromosome insert YHX39 (DXS727) and the polymorphic phage clone QST59 (DXS319). A genomic clone, FT1 (DXS726), 3' to DMD, was also characterized. Portions of the three probes were sequenced and primer pairs were generated to amplify a sequence-tagged site within each probe. Amplification of DNA from patients confirmed the deletion results obtained by Southern blot analysis, and these three sequence-tagged sites were successfully combined for triplex PCR. In addition to facilitating molecular genetic diagnosis in Xp21, these probes can be used to identify additional YACs and other probes to further increase the genomic information and diagnostic capabilities in this region.
Base Sequence↗
Differentials in Australian interstate migration 1911-21 to 1961-66 by place of birth, sex and age.
"Without direct census data on migration prior to 1971, there is a deficit of information on Australian interstate migration this century. This paper uses the Census Enumeration Ratio technique to produce estimates of net interstate migration by birthplace, sex and age for the intercensal periods between 1911 and 1966. Contrasts in the propensity to migrate of different segments of the population are revealed. These correspond with overseas research and Australian findings for the subsequent period."
Age Factors↗
An ACTH receptor on human mononuclear leukocytes. Relation to adrenal ACTH-receptor activity.
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Adrenal Cortex↗
Modelling the determinants of trans-Tasman migration after World War II.
"This paper identifies the economic and demographic factors responsible for migration flows between Australia and New Zealand by means of a probabilistic model of emigration in both directions. The largely uncontrolled flows between the two countries have the same determinants as those commonly found in studies of internal migration. The cost of migration (proxied by the real cost of air travel), labour market conditions and the potential earnings differential play a role, although the results are modified by the incidence of return migration and age composition."
Age Factors↗
Population growth and redistribution in Australia: 1911-1966.
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Australia↗
Mandibular growth, condyle position and Fränkel appliance therapy.
A statistical evaluation of condyle position and mandibular length changes in 10 patients after one year of Fränkel appliance therapy, finding the condyle forward on the eminence in 4 of them. Large variations were found in mandibular growth, with no significant difference from the means of patients treated with the Edgewise appliance.
Activator Appliances↗
On estimating internal migration for open populations.
"The purpose of this note is to review the case for using the forward census survival ratio (FCSR) method for estimating internal migration. Through this technique seems likely, on certain criteria, to offer usable estimates of migration, it suffers from what some critics regard as a crucial weakness, namely a sensitivity to inernational migration. It is argued here, however, that this deficiency is less damaging than others have made it out to be. Consequently, a case can be made for preferring the FCSR method to other methods."
Demography↗
Quantitative analysis of wound healing.
In this article, we initially review several problems associated with the design and interpretation of certain types of experiments currently used to study wound healing, drawing attention to the fact that applications for standard statistical techniques in the analysis of the experimental results are often of limited value. We then argue that, because of the special nature of wound healing data, curve fitting of empirical model equations can often provide a convenient way to summarize treatment effects with large data sets. The various ways in which this technique could be used to facilitate the interpretation of experimental wound healing results are then explored. To illustrate this approach, we then took several wound healing experiments and introduced possible models that could be used, paying particular attention to simple equations with the smallest possible number of parameters. For each equation, the way that the parameters of the model could be interpreted with regard to the biologic effects represented is given. Examples are given to show the application of each model discussed theoretically in the interpretation of some typical experimental data sets.
Journal Article↗
Expression of TGF-beta and its receptors in murine fetal and adult dermal wounds.
The transforming growth factor-betas (TGF-betas) are of major importance in wound healing and have been implicated in the scar-less wound repair observed in fetuses. Few studies have characterised the role of TGF-beta in fetal wound repair and to date no studies have characterised the expression of its receptors within non-scarring fetal wounds. We have localised the TGF-beta isoforms beta1, beta2 and beta3 and its two receptors, TGF-betaRI and TGF-betaRII in both adult and fetal dermal murine wounds. We observed low level immunofluorescence of TGF-beta1 and TGF-beta2 in fetal wounds and although TGF-beta3 staining was observed in the epidermis of fetal skin, there was no upregulation in response to injury. By contrast, all three isoforms were strongly expressed in adult wounds. Similar to its ligands, TGF-beta receptor expression was increased post-wounding in the adult wounds. However, in contrast, no mRNA or protein for either of the TGF-beta receptors was observed in response to wounding in the fetal dermis although there was both mRNA and protein expression of both the receptors localised within the fetal alimentary tract, one of the few fetal organs which does scar post-injury. The differences that we observed in the expression of TGF-beta and its receptors in adult and fetal wounds could be important in the absence of scar formation that is observed in the fetus.
Activin Receptors, Type I↗
A comparative cost analysis of newborn screening for classic congenital adrenal hyperplasia in Texas.
OBJECTIVE: Texas mandates a two-test newborn screening program for congenital adrenal hyperplasia (CAH): one test at birth and a second test at approximately one to two weeks after birth. The authors compared the dollar cost of detecting infants with CAH clinically and through the screening program. METHODS: The authors estimated the costs of screening newborns in 1994 for CAH, including resources used by the Texas Department of Health and the broader cost to society. RESULTS: Fifteen infants with classic CAH were diagnosed in Texas in 1994 among 325,521 infants born (1:21,701 cumulative incidence). Seven infants were detected clinically and the others were detected through screening, six on the first screen and two on the second screen. The first screen identified all previously undetected infants with severe salt-wasting CAH. The cumulative cost to diagnose the seven infants detected clinically was $79,187. The incremental costs for the screening program were $115,169 per additional infant diagnosed through the first screen and $242,865 per additional infant diagnosed through the second screen. CONCLUSIONS: If the goal is early diagnosis of infants with the severe salt-wasting form of CAH, a single screen is effective. If the goal is to detect infants with the simple virilizing form of the disorder who may benefit from early treatment, the second screen is necessary, but it is not as cost-effective as the first screen.
Adrenal Hyperplasia, Congenital↗