Evidence of the effects of intrathecal baclofen for spastic and dystonic cerebral palsy. AACPDM Treatment Outcomes Committee Review Panel.
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Baclofen↗
Biomedical subjects
S Campbell
Publications and source records attributed to S Campbell.
Squamous cell carcinoma in an area of necrobiosis lipoidica diabeticorum: a case report.
Ulceration in an area of necrobiosis lipoidica diabeticorum is a frequent complication but malignant transformation is rare. One such case is reported in a diabetic patient and the literature is reviewed.
Carcinoma, Squamous Cell↗
The image of the children's nurse: a study of the qualities required by families of children's nurses' uniform.
Traditional views of the nurse see 'her' in a nurse's uniform, whether she be a 'sex symbol', 'angel of mercy' or 'battle axe'. Children's nursing has, over recent years, moved away from the idea of the uniform into more child friendly clothes, though the traditional uniform is still presented to the public by the media. The staff members of a Children's Outpatients Department (COPD) of a large acute hospital requested knowledge of the qualities families required from the uniform of nurses caring for them, prior to any change in uniform. This study aimed to develop an understanding of these qualities via the use of a survey presented to those attending the COPD. The findings indicate that there is a complex relationship between the qualities that families wish the uniform to present. A balance is needed between presenting a professional authority figure, providing security for families and suggesting an approachable figure, to allow effective communication between staff and families.
Adult↗
Interactions between hy1 and gun mutants of Arabidopsis, and their implications for plastid/nuclear signalling.
Lhcb and other nuclear genes for chloroplastic proteins are regulated by several signals. Among them, light and retrograde signals from the plastid itself appear to act through closely related mechanisms. To investigate this interaction, we analysed an Arabidopsis mutant, hy1, deficient in plastidic heme oxygenase. hy1 is defective in phytochrome chromophore biosynthesis, which has other indirect effects on tetrapyrrole metabolism. We generated double mutants between hy1-6.2, genetically a null mutation, and three known gun (genome uncoupled) mutants, defective in retrograde plastid signalling. Recent molecular evidence shows GUN5 to be involved in tetrapyrrole metabolism (N. Mochizuki and J. Chory, manuscript in preparation). We observed hy1gun4 to be semi-albino plants, and hy1gun5 albino lethal, in a high-light-sensitive manner. Both double mutants showed defective greening and chloroplast development, and expressed Lhcb at reduced levels specifically in high light. Their degree of 'genome uncoupling' (Lhcb expression in the absence of functional chloroplasts) was similar to that observed in single mutants. These results can be interpreted as a metabolic (rather than genetic) interaction between HY1 and GUN4 or GUN5, and this in turn supports the involvement of tetrapyrroles as plastid signals. The tetrapyrrole precursor 5-aminolevulinic acid (ALA) inhibited Lhcb expression in hy1. Surprisingly, ALA also rescued photomorphogenesis of hy1. We speculate that either one tetrapyrrole intermediate, which can accumulate anomalously in hy1, or an altered ratio between two intermediates, plays a role as a repressor of Lhcb expression. gun1 did not exacerbate the plastid or Lhcb expression phenotype of hy1. This can be interpreted as a role for gun1 strictly on the same pathway as hy1 or, more likely, as evidence for the existence of at least one separate, non-tetrapyrrole related plastid signal.
Aminolevulinic Acid↗
A prospective management study of slow-release aspirin in the palliation of uteroplacental insufficiency predicted by uterine artery Doppler at 20 weeks.
OBJECTIVE: To investigate the effect of low-dose, slow-release aspirin in reducing the incidence and/or severity of pregnancy complications in women identified as high risk of developing problems associated with uteroplacental insufficiency, namely pre-eclampsia or delivering a small-for-gestational age (SGA) baby. DESIGN: A prospective, randomized management study. One thousand and twenty-two women of mixed parity underwent color flow/pulsed Doppler (CFPD) imaging of the uterine arteries at the time of the 17-23 week (mean 19.9) anomaly scan. Women who were screen positive were randomized to a control or treatment group. The treatment group was given 100-mg slow-release aspirin (Disprin CV) daily and followed up at regular intervals. Women in the routine group received routine antenatal care. Main outcome measures were pre-eclampsia and SGA < 3rd centile. Secondary outcome measures were: SGA < 10th centile, pre-eclampsia requiring delivery before 34 weeks, placental abruption, an Apgar score < 7 at 5 min, admission to neonatal intensive care unit or a pregnancy that resulted in a stillbirth or neonatal death. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for severe and any complications. RESULTS: Two hundred and sixteen women were screen positive according to the defined criteria. One hundred and three women were assigned to the treatment group and 113 to the control group. The difference in the incidence of pre-eclampsia and SGA < 3rd centile between the control and treatment groups did not reach statistical significance. There was a statistically significant reduction in any (OR 0.41 (CI 0.35-0.45), P < 0.01) and severe pregnancy complications (OR 0.43 (CI 0.21-0.84), P < 0.05) in the treatment group compared with the controls. CONCLUSIONS: The administration of slow-release aspirin to women identified as high risk, using color Doppler imaging of the uterine arteries at 20 weeks' gestation, did not significantly alter the incidence of pre-eclampsia or delivery of a SGA baby. It did, however, improve the outcome by reducing the overall incidence of complications associated with uteroplacental insufficiency.
Adult↗
Fetal biometry at 4300 m compared to sea level in Peru.
OBJECTIVES: The aim of this study was to compare ultrasound fetal size at high altitude and sea level. METHODS: Three hundred and thirty-four women in Cerro de Pasco at 4300 m (14,100 ft) altitude and 278 women in Lima (sea level) were recruited to the study. Ultrasound fetal biometry was carried out between 14 and 42 weeks of gestation. Biparietal diameter, occipitofrontal diameter, abdominal circumference and femur length were measured and head circumference and estimated fetal weight were derived from these data. Two hundred and seventy-seven women (82.9%) in Cerro de Pasco and 216 (77.7%) in Lima had normal singleton pregnancies and certain menstrual dates. These women were selected for statistical analysis. Fractional polynomial regression analysis on gestational age was performed, controlling for maternal height and parity. RESULTS: Fetal biometry measurements were significantly smaller in Cerro de Pasco compared with Lima. When gestation bands were compared this effect was present from 25 to 29 weeks onwards, and was greater in the abdominal circumference than in the head circumference and femur length (ratios Cerro de Pasco: Lima, 0.96, 0.97 and 0.98, respectively). Estimated fetal weight was also significantly lower in Cerro de Pasco (ratio 0.88), as were birthweights (ratio 0.88). If the centiles derived from the Lima population were applied for Cerro de Pasco, 11.2% of all estimated fetal weights would be below the fifth centile, and 1.08% above the ninety-fifth. CONCLUSIONS: These data suggest that at high altitude, all fetal biometry measurements follow a lower trajectory than at sea level. Specific biometry charts should therefore be used for obstetric ultrasound at high altitude.
Altitude↗
The prenatal diagnosis of Binder syndrome before 24 weeks of gestation: case report.
A case of Binder syndrome was diagnosed at 21 weeks of gestation using two-dimensional and three-dimensional ultrasound. The first indication of any abnormality was a flattened fetal nose demonstrated in the mid-sagittal plane. Further ultrasound imaging showed the virtual absence of the naso-frontal angle, giving the impression of a flat forehead and small fetal nose. Suspected mild hypertelorism was also seen using transverse and coronal planes. Differential diagnosis of this condition is discussed.
Adult↗
Three-dimensional power Doppler imaging in the assessment of Fallopian tube patency.
OBJECTIVE: The aim of the study was to evaluate the feasibility of three-dimensional power Doppler imaging (3D-PDI) in the assessment of the patency of the Fallopian tubes during hysterosalpingo-contrast sonography (HyCoSy). METHODS: Women attending the fertility clinic were offered a Fallopian tubal patency test as part of the initial investigation. Hysterosalpingo-contrast sonography using contrast medium Echovist was performed on 67 women. Findings on the two-dimensional (2D) gray-scale scanning and three-dimensional power Doppler imaging were compared. The first technique visualizes positive contrast in the Fallopian tube; the second demonstrates flow of medium through the tube. RESULTS: Contrast medium Echovist produced prominent signals on the 3D-PDI image. Free spill from the fimbrial end of the Fallopian tubes was demonstrated in 114 (91%) tubes using the 3D-PDI technique and in 58 (46%) of tubes using conventional HyCoSy. The mean duration of the imaging procedure was less with 3D-PDI, but the operator time which included postprocedure analysis of the stored information was similar. A significantly lower volume of contrast medium (5.9 +/- 0.6 mL) was used for 3D-PDI in comparison with that (11.2 +/- 1.9 mL) used for conventional 2D HyCoSy. CONCLUSION: Color coded 3D-PDI with surface rendering allowed visualization of the flow of contrast through the entire tubal length and free spill of contrast was clearly identified in the majority of cases. The 3D-PDI method appeared to have advantages over the conventional HyCoSy technique, especially in terms of visualization of spill from the distal end of the tube, which was achieved twice as often with the 3D technique. Although the design of the investigation did not allow the side effects of the two techniques to be compared, the shorter duration of the imaging and lower volume of the contrast medium used suggested that the 3D-PDI technique might have a better side-effect profile. The 3D-PDI technique allowed better storage of the information for re-analysis and archiving than conventional HyCoSy.
Contrast Media↗
Methodological issues in the use of guidelines and audit to improve clinical effectiveness in breast cancer in one United Kingdom health region.
AIMS: To develop a system to improve and monitor clinical performance in the management of breast cancer patients in one United Kingdom health region. DESIGN: An observational study of the changes brought about by the introduction of new structures to influence clinical practice and monitor change. SETTING: North Thames (East) Health region, comprising seven purchasing health authorities and 21 acute hospitals treating breast cancer. SUBJECTS: The multi-disciplinary breast teams in 21 hospitals and an audit sample of 419 (28%) of the breast cancer patients diagnosed in 1992 in the region. INTERVENTIONS: Evidence-based interventions for changing clinical practice: regional guidelines, senior clinicians acting as < >, audit of quality rather than cost of services, ownership of data by clinicians, confidential feed-back to participants and education. OUTCOME MEASURES: Qualitative measures of organizational and behavioural change. Quantitative measures of clinical outcomes compared to guideline targets and to results from previous studies within this population. RESULTS: Organizational changes included the involvement, participation of and feedback to 16 specialist surgeons and their multidisciplinary teams in 21 hospitals. Regional clinical guidelines were developed in 6 months and the dataset piloted within 9 months. The audit cycle was completed within 2 years. The pilot study led to prospective audit at the end of 2 years for all breast cancers in the region and a 15-fold increase in high quality clinical information for these patients. Changes in clinical practice between 1990 and 1992 were observed in the use of chemotherapy (up from 17-23%) and axillary surgery (up from 46-76%). CONCLUSIONS: The approach used facilitated rapid change and found a balance between local involvement (essential for sustainability within a hospital setting) and regional standardization (essential for comparability across hospitals). The principles of the approach are generalized to other cancers and to other parts of the UK and abroad.
Breast Neoplasms↗
Does blastocyst culture eliminate paternal chromosomal defects and select good embryos?: inheritance of an abnormal paternal genome following ICSI.
Following intracytoplasmic sperm injection (ICSI), approximately 60-70% of oocytes are fertilized and of these embryos, approximately 45% withstand in-vitro culture conditions to produce healthy blastocysts. The efficiency of implantation of 2-4-cell embryos selected at the pronuclear stage and that of blastocysts are comparable. However, prolonged selection of embryos in vitro (4-5 days), has been proposed to eliminate chromosomal abnormalities, more specifically those inherited by defective spermatozoa. This hypothesis is based upon the assumption that the paternal genetic contribution is indispensable for blastocyst development. Here we examine this hypothesis and suggest that phenotypic manifestation of paternal genomic abnormalities might not occur prior to implantation. In addition to the parent-of-origin effect during embryogenesis, blastocyst transfer may not prevent the inheritance of genetic defects involving 'male factor' loci.
Animals↗
Spatially regulated differentiation of endometrial vascular smooth muscle cells.
Angiogenesis within the human endometrium involves the development of arterioles and elaboration of a capillary network. It was postulated that maturation of these arterioles involves a spatially regulated process of vascular smooth muscle cell (VSMC) differentiation. The endometrial vascular tree was therefore examined immunohistochemically for evidence of longitudinal and radial gradients of VSMC phenotype. Twenty-three hysterectomy specimens and 15 first trimester decidual tissues were studied. Five cytoskeletal markers (alpha and gamma-smooth muscle (sm) actin, sm myosin, desmin, vimentin), three endothelial markers (CD31, CD34, factor VIII related antigen) and two steroid receptors (oestrogen and progesterone) were detected immunohistochemically. alpha-sm actin was present throughout the wall of basal arterial segments and extended longitudinally towards the endometrial surface. Sm myosin expression was more restricted longitudinally and radially within in the vascular tree. The expression of gamma-sm actin was even more restricted than myosin. In first trimester decidua, however, gamma-sm actin was widely distributed within the wall of spiral arteries that were not invaded by trophoblast. Oestrogen and progesterone receptors were present in peri-vascular stromal cells but absent from vascular smooth muscle and endothelium. Endometrial VSMC differentiation involves a progressive increase in cytoskeletal complexity and occurs in a spatially regulated fashion.
Actins↗
Mosaic characteristics of human endometrial epithelium in vitro: analysis of secretory markers and cell surface ultrastructure.
Specific terminal carbohydrate structures and mucin-associated glycans increase in expression within the human endometrial epithelium during the secretory phase of the menstrual cycle but exhibit wide intercellular variation. We postulated that variation in glycosylation between cells would produce differences in the glycocalyx and result in complex mixtures of cells bearing different combinations of glycans. MUC-1 mucin, keratan sulphate and fucosylated lactosaminoglycans were examined in epithelial gland fragment cultures with antibodies (HMFG1, 5D4) and a lectin (Dolichos biflorus agglutinin). The glycocalyx was examined by transmission and high resolution scanning electron microscopy. The data were related to patterns of expression seen in vivo. The MUC-1 mucin was expressed relatively uniformly in culture, but heterogeneity was evident in mucin sialylation within the epithelial cell population. Double labelling of gland explant cultures for combinations of fucosylated lactosaminoglycans, keratan sulphate and MUC-1 demonstrated cells expressing all combinations of these markers. Ultrastructural examination confirmed remarkable intercellular variation in the glycocalyx. Though the human endometrial epithelium is relatively morphologically homogeneous, these observations reveal complex variations of cell surface glycosylation between neighbouring cells and suggest that secretory function might vary in a similar fashion.
Adult↗
Advanced ultrasound examination in the management of subfertility.
The development of new ultrasound techniques such as colour power angiography (CPA) and three-dimensional ultrasound may expand the role of ultrasound in the management of the infertile couple. Measurements of follicular blood flow velocities appears to predict the development of a healthy oocyte while high ovarian stromal vascularity is associated with polycystic ovary and the risk of ovarian hyperstimulation syndrome. Three-dimensional ultrasound with CPA provides spatial evaluation of volume flow in pelvic organs which has been used to measure vascular changes in the endometrium and improve the evaluation of tubal patency.
Angiography↗
Fludarabine induced intestinal pseudo-obstruction: case report and literature review.
Intestinal pseudo-obstruction is a recognized but rare complication of chemotherapy. Vinca alkaloids and cytarabine have been reported to be associated with intestinal pseudo-obstruction. We report a case of fludarabine induced severe intestinal pseudo-obstruction in a 66-year-old man suffering from non-Hodgkin's lymphoma, and describe our successful management of this with a combination of parasympathomimetic and mechanical decompression, after failure of conservative management.
Aged↗
A rapid, automated enzymatic fluorometric assay for determination of D-arabinitol in serum.
A rapid enzymatic fluorometric assay for measuring D-arabinitol in serum was developed using recombinant D-arabinitol dehydrogenase from Candida albicans (rArDH). rArDH was produced in Escherichia coli and purified by dye-ligand affinity chromatography. rArDH was highly specific for D-arabinitol, cross-reacting only with xylitol (4.9%) among all polyols tested. A Cobas Fara II centrifugal autoanalyzer (Roche) was used to measure NADH fluorometrically when rArDH and NAD were added to serum extracts, and D-arabinitol concentrations were calculated from standard curves derived from pooled human serum containing known amounts of D-arabinitol. The method was precise (mean intra-assay coefficients of variation [CVs], 0.8%, and mean interassay CVs, 1.6%) and rapid (3.5 min per assay) and showed excellent recovery of added D-arabinitol in serum (mean recovery rate, 101%). The mean and median D-arabinitol/creatinine ratios were 2.74 and 2.23 microM/mg/dl, respectively, for the 11 patients with candidemia compared to 1.14 and 1.23 microM/mg/dl, respectively, for 10 healthy controls (P < 0.01). These results confirm earlier studies showing that serum D-arabinitol measurement may help to promptly diagnose invasive candidiasis. The technique shows a significant improvement in terms of accuracy, cost, simplicity, specificity, and speed compared with gas chromatography, mass spectrometry, and earlier enzymatic assays.
Candida albicans↗
Infectivity of Moloney murine leukemia virus defective in late assembly events is restored by late assembly domains of other retroviruses.
The p12 region of the Moloney murine leukemia virus (M-MuLV) Gag protein contains a PPPY motif important for efficient virion assembly and release. To probe the function of the PPPY motif, a series of insertions of homologous and heterologous motifs from other retroviruses were introduced at various positions in a mutant gag gene lacking the PPPY motif. The assembly defects of the PPPY deletion mutant could be rescued by insertion of a wild-type PPPY motif and flanking sequences at several ectopic positions in the Gag protein. The late assembly domain (L-domain) of Rous sarcoma virus (RSV) or human immunodeficiency virus type 1 (HIV-1) could also fully or partially restore M-MuLV assembly when introduced into matrix, p12, or nucleocapsid domains of the mutant M-MuLV Gag protein lacking the PPPY motif. Strikingly, mutant viruses carrying the RSV or the HIV-1 L-domain at the original location of the deleted PPPY motif were replication competent in rodent cells. These data suggest that the PPPY motif of M-MuLV acts in a partially position-independent manner and is functionally interchangeable with L-domains of other retroviruses. Electron microscopy studies revealed that deletion of the entire p12 region resulted in the formation of tube-like rather than spherical particles. Remarkably, the PPPY deletion mutant formed chain structures composed of multiple viral particles linked on the cell surface. Many of the mutants with heterologous L-domains released virions with wild-type morphology.
Amino Acid Motifs↗
Advances in ultrasound assessment in the establishment and development of pregnancy.
Current data demonstrate that angiogenesis in the ovaries and uterus is an essential component of both follicular and luteal phases of menstrual cycle, tightly correlating with the levels of bioactive substances such as hormones, growth factors and interleukins. Ultrasound is used principally to demonstrate follicular growth, a receptive triple layer endometrium and to exclude pathologies such as fibroids and ovarian tumours. However, the development of new technologies such as CDI, CPA, 3D-US, 3D-CPA is now set to expand the role of ultrasound in the assessment of the processes in the ovaries, uterus and early pregnancy. There is growing evidence that studies of peri-follicular vascularity will predict the development of a healthy oocyte and subsequently an embryo. Endometrial blood flow studies with conventional CDI and the newer techniques of CPA and 3D-CPA will be important in predicting endometrial receptivity. Ovarian stromal vascularity appears to correlate with vascular endothelial growth factor (VEGF) levels and high vascularity is associated with PCO and a risk of ovarian hyperstimulation syndrome. 3D-CPA may improve our ability to assess ovarian and endometrial vascularization and blood circulation, to diagnose tubal patency. Increasingly, 3D ultrasound is being applied to diagnose the pathology of early singleton and multiple pregnancies.
Endometrium↗
Microscopic focal cryptitis associated with sodium phosphate bowel preparation.
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Administration, Oral↗