Risk and advice in child neurology.
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Child↗
Biomedical subjects
S Green
Publications and source records attributed to S Green.
Expert system assisted pharmacophore identification
An expert system for automatic perception of pharmacophoric groups is presented. Important features include consideration of the protonation state at physiological pH and detection of potential tautomerism. This perception information is used in the generation of pharmacophores using clique detection.
Journal Article↗
ATM heterozygosity and breast cancer: screening of 37 breast cancer patients for ATM mutations using a non-isotopic RNase cleavage-based assay.
Based upon the results of several epidemiologic studies, it has been suggested that women who are carriers for a mutation in the ataxia telangiectasia-mutated (ATM) gene are susceptible for the development of breast cancer. Therefore, 37 consecutive breast cancer patients were screened for the presence of a germline ATM mutation using a non-isotopic RNase cleavage-based assay (NIRCA). This paper reports the first use of NIRCA for detection of ATM mutations in breast cancer patients. Using this assay, no ATM mutations were found in our patient population. This result is similar to the findings of other studies that have employed approaches complementary to NIRCA.
Adult↗
Prevalence of hepatitis C virus infection among injecting drug users in Glasgow 1990-1996: are current harm reduction strategies working?
OBJECTIVES: To determine the prevalence of HCV antibodies among injecting drug users and to gauge the effectiveness of needle/syringe exchange in preventing the transmission of HCV infection. METHODS: Between 1990-1994 and in 1996, annual cross-sectional surveys of injecting drug users in Glasgow were conducted. In order to ensure as representative a sample as possible, the 1949 respondents were recruited from both 'in-treatment' and 'out-of treatment' settings. Injectors were interviewed about their risk behaviours for blood-borne viruses and provided a saliva sample which was initially tested, anonymously, for HIV antibodies, and subsequently tested for hepatitis C infection. RESULTS: Among 1949 injectors, the prevalence of salivary antibodies, indicative of hepatitis C viraemia, was 61%(95%, confidence interval (CI) 59%-63%): the estimated prevalence of serum antibody positivity was 72%. Length of injecting, year of commencing drug injecting and the number of times in prison were predictive of antibody positivity. Thirty-one per cent of injectors who commenced their injecting after 1992, following the full establishment of needle/syringe exchange in the city, were salivary antibody positive, and the majority of their infections were acquired outside the prison setting. Respondents who began injecting after the introduction of needle/syringe exchange in the city were significantly less likely to test HCV antibody positive than those who commenced injecting prior to the advent of needle/syringe exchange, after adjusting for length of injecting career. CONCLUSION: The prevalence of HCV among injectors in Glasgow has decreased during the era of needle/syringe exchange. However, there is evidence to suggest that the incidence of infection remains high. Since the prevalence of hepatitis C viraemia among the city's injecting population is extremely high, ongoing transmission is inevitable unless more effective interventions are identified and implemented urgently.
Adolescent↗
Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group.
AIMS: The primary objective was to estimate prevalence of malnutrition on admission to four hospitals. Secondary objectives included assessing the relationship between nutritional status and length of hospital stay, numbers of new prescriptions, new infections and disease severity. METHODS: We entered eligible patients according to predefined quotas for elective and emergency admissions to 23 specialties. We measured height, weight, Body Mass Index and anthropometrics, and recorded history of unintentional weight loss. Patients who had lost > or = 10% of their body weight, had a Body Mass Index <20, or had a Body Mass Index <20 with one anthropometric measurement <15th centile were considered malnourished. RESULTS: Of 1611 eligible patients, 761 did not participate; 269 were too ill; 256 could not be weighed; and 236 refused consent. Eight hundred and fifty were subsequently evaluated. Prevalence of malnutrition on admission was 20%. Length of stay, new prescriptions and infections and disease severity were significantly higher in the malnourished. CONCLUSIONS: One patient in every five admitted to hospital is malnourished. Although this figure is unacceptably high, it may underestimate true prevalence. Malnutrition was associated with increased length of stay, new prescriptions and infections. Malnutrition may also have contributed to disease severity.
Adolescent↗
Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain.
OBJECTIVE: To assess the intraexaminer and interexaminer reliability of a multidimensional spinal diagnostic method commonly used by chiropractors. DESIGN: An intraexaminer and interexaminer Latin square, repeated measures reliability study. The techniques of diagnosis under investigation included visual postural analysis, pain description by the patient, plain static erect x-ray film of the lumbar spine, leg length discrepancy, neurologic tests, motion palpation, static palpation, and orthopedic tests. PARTICIPANTS: Three experienced chiropractors examined 19 patients, and 2 experienced chiropractors examined 10 and 9 patients, respectively, who were suffering from chronic mechanical low-back pain. RESULTS: Intraexaminer reliability of the decision to manipulate a certain spinal segmental level was moderate (kappa = 0.47). The interexaminer agreement pooled across all spinal joints indicated fair agreement (kappa = 0.27). Interexaminer reliability for individual examiner pairs for the L4/L5 segmental level was slight (kappa = 0.09). At the L5/S1 level, the interexaminer reliability was fair (kappa = 0.25). For the sacroiliac joints, interexaminer reliability was slight (kappa = 0.04 and 0.14). CONCLUSION: This study of commonly used chiropractic diagnostic methods in patients with chronic mechanical low-back pain to detect manipulable lesions in the lower thoracic spine, lumbar spine, and the sacroiliac joints has revealed that the measures are not reproducible. The implementation of these examination techniques alone should not be seen by practitioners to provide reliable information concerning where to direct a manipulative procedure in patients with chronic mechanical low-back pain.
Adult↗
The benefits of random variable practice for accuracy and temporal error detection in a rapid aiming task.
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Adolescent↗
Adult Attachment Interview: linkages with dimensions of emotional availability for mothers and their pre-kindergarteners.
Maternal attachment representations were assessed using the George, Kaplan, and Main (1985) Adult Attachment Interview (AAI), and emotional availability during observed mother-child interactions was assessed using the third edition of the Emotional Availability (EA) Scales (Biringen, Robinson, & Emde, 1998). This edition of EA included four parental scales and two child scales (Maternal Sensitivity, Structuring, Nonintrusiveness and Nonhostility; and Child Responsiveness and Child Involvement). Separate Hierarchical Multiple Regressions (HMRs) were computed to examine the prediction of the separate EA dimensions from demographic information, the AAI classification, and AAI scales. These analyses indicated that each of the EA dimensions (with the exception of maternal nonintrusiveness and nonhostility) was predicted by the AAI classification and/or AAI scales. Using three-step HMRs, the strongest prediction was for maternal sensitivity where 54% of the total variance in maternal sensitivity was explained by maternal education, AAI classification, and AAI 'state of mind' scales. Maternal nonhostility was predicted by maternal education and gender of the child, with lower-income mothers and mothers of girls demonstrating greater hostility.
Adult↗
Dengue viremia titer, antibody response pattern, and virus serotype correlate with disease severity.
Viremia titers in serial plasma samples from 168 children with acute dengue virus infection who were enrolled in a prospective study at 2 hospitals in Thailand were examined to determine the role of virus load in the pathogenesis of dengue hemorrhagic fever (DHF). The infecting virus serotype was identified for 165 patients (DEN-1, 46 patients; DEN-2, 47 patients; DEN-3, 47 patients, DEN-4, 25 patients). Patients with DEN-2 infections experienced more severe disease than those infected with other serotypes. Eighty-one percent of patients experienced a secondary dengue virus infection that was associated with more severe disease. Viremia titers were determined for 41 DEN-1 and 46 DEN-2 patients. Higher peak titers were associated with increased disease severity for the 31 patients with a peak titer identified (mean titer of 107.6 for those with dengue fever vs. 108.5 for patients with DHF, P=.01). Increased dengue disease severity correlated with high viremia titer, secondary dengue virus infection, and DEN-2 virus type.
Adolescent↗
The potential use of polymer gel dosimetry in boron neutron capture therapy.
Polymer gels with and without 60 ppm of 10B were exposed to an epithermal neutron beam produced by the Dynamitron at the University of Birmingham on two separate occasions. Eight vials containing the gel, four with and four without boron, were irradiated in pairs in a water phantom for 5 h. The maximum dose was calculated to be 9 Gy in A-150 tissue equivalent plastic, 4 cm deep in the phantom. Measurements were made of the variation of relaxation rates of the gels with depth in a phantom. These were compared with calculations using the MCNP Monte Carlo program and the gel response followed the general trend of the results of the calculations. The calculations showed that the absence of boron gave 66.1% and 44.3% of the absorbed dose with boron and the measurements showed the response of the gel without boron to give 65+/-2% and 41+/-6% of the response with boron for the two halves of the first vial. All the gel measurements showed an enhancement in absorbed dose when boron was added. These results indicate that polymer gels may have a role in measuring the enhancement of absorbed dose due to boron in an epithermal or thermal neutron.
Boron Neutron Capture Therapy↗
Should ICSI be the treatment of choice for all cases of in-vitro conception?
The objective of this study was to examine different clinical scenarios of in-vitro conception, viz. fertilization with conventional IVF, IVF with high insemination concentration (HIC) and intracytoplasmic sperm injection (ICSI), and assess on a sibling oocyte comparison the hypothesis that ICSI should be performed in all cases requiring in-vitro conception. ICSI with husband's spermatozoa had a higher incidence of fertilization as compared with IVF or IVF with HIC with donor spermatozoa (if previous failure of fertilization had occurred) for unexplained infertility. Similarly, ICSI with husband's spermatozoa had as high an incidence of fertilization as IVF with donor spermatozoa for patients with severe oligozoospermia, asthenozoospermia and/or teratozoospermia, even when the spermatozoa were not selected for their morphology. Two studies were performed to assess ICSI in potential oocyte-related failure of IVF, viz. when fertilization occurred in >50% of oocytes for one group of patients, and in <50% of oocytes in a second group. In both of these studies a significant proportion of the oocytes that failed to fertilize with conventional IVF eventually fertilized after ICSI. The overall conclusion was that ICSI as a first option offers a higher incidence of fertilization, maximizes the number of embryos and minimizes the risk of complete failure of fertilization for all cases requiring in-vitro conception. However, among other concerns, current knowledge of ICSI as an outcome procedure does not provide the confidence to use this process in all cases of IVF for the time being.
Female↗
An occupational therapy Internet school.
Four centres in the UK, Belgium, the Netherlands and Sweden have collaborated to provide Internet-based courses for student and professional occupational therapists. The basis of the occupational Therapy Internet School (OTIS) is the concept of the 'virtual college'. This comprises the design and implementation of a sophisticated Internet-based system through which courses can be managed, prepared and delivered on line, and through which students can communicate both with the staff and their peers. The aim is to support and facilitate the whole range of educational activities within a remote electronic environment.
Education, Distance↗
Mutation detection in the human HSP7OB' gene by denaturing high-performance liquid chromatography.
Variances, particularly single nucleotide polymorphisms (SNP), in the genomic sequence of individuals are the primary key to understanding gene function as it relates to differences in the susceptibility to disease, environmental influences, and therapy. In this report, the HSP70B' gene is the target sequence for mutation detection in biopsy samples from human prostate cancer patients undergoing combined hyperthermia and radiation therapy at the Dana-Farber Cancer Institute, using temperature-modulated heteroduplex analysis (TMHA). The underlying principles of TMHA for mutation detection using DHPLC technology are discussed. The procedures involved in amplicon design for mutation analysis by DHPLC are detailed. The melting behavior of the complete coding sequence of the target gene is characterized using WAVEMAKER software. Four overlapping amplicons, which span the complete coding region of the HSP70B' gene, amenable to mutation detection by DHPLC were identified based on the software-predicted melting profile of the target sequence. TMHA was performed on PCR products of individual amplicons of the HSP70B' gene on the WAVE Nucleic Acid Fragment Analysis System. The criteria for mutation calling by comparing wild-type and mutant chromatographic patterns are discussed.
Chromatography, High Pressure Liquid↗
Toxicity of insecticides for control of freshwater Culex annulirostris (Diptera: Culicidae) to the nontarget shrimp, Caradina indistincta (Decapoda: Atyidae).
Laboratory evaluations were conducted in southeastern Queensland, Australia, to determine the toxicities of two organophosphate compounds (temephos and pirimiphos-methyl), an insect growth regulator (s-methoprene), and an entomopathogenic bacterium (Bacillus thuringiensis variety israelensis de Barjac [B.t.i.]) to Culex annulirostris (Skuse), an Australian freshwater mosquito vector of arboviruses, and to Caradina indistincta Calman, a co-habiting nontarget shrimp species. S-methoprene and B.t.i. were safest for Cx. annulirostris control with lethal dose ratios (LC95 nontarget/LC95 target) of 3,300 and 846,000, respectively. In contrast, lethal dose ratios for temephos and pirimiphos-methyl were 0.05 and 0.00005, respectively, suggesting that they are environmentally unsuitable. Based on their high lethal dose ratios, s-methoprene and B.t.i. are recommended for control of larval Cx. annulirostris in Australian freshwater habitats.
Animals↗
Screening of abdominal aortic aneurysm: a pragmatic approach.
In order to evaluate the feasibility of a selective screening programme for abdominal aortic aneurysm (AAA) within an urban setting and assess its impact on the expected increase in workload for the local hospital(s), a population based, prospective study was performed. A total of 4823 men aged 65 years were invited for ultrasound examination of the abdominal aorta between January 1993 and April 1997 as part of a general practice-based aneurysm screening programme covering two districts with a general hospital each. All examinations were carried out by senior radiographers using a portable B mode grey scale machine and a 3.5 MHz curvi-linear array probe. Patients with a maximum aortic diameter of over 3 cm were annually recalled, those with over 4 cm were referred to hospital for an out-patient's appointment. Those with AAA greater than 5 cm were considered for surgery. Of those approached, 3497 (72.5%) took part in the study, 1206 (25%) did not attend and 120 (2.5%) were excluded by their general practitioners (GPs) on medical grounds. Of the men taking part, 3130 (89.5%) had an aortic diameter equal to or less than 2.5 cm, 196 (5.6%) between 2.6 and 3.0 cm, and 171 (4.9%) had aortic diameters greater than 3 cm--29 of whom had AAA greater than 5 cm with a mean diameter of 6.0 cm (range 5.1-9.0 cm). Of 127 men with an initial diameter of 3.1-4.0 cm (mean progression in size of 2.3 mm/year), 22 enlarged to > 4 cm and 3 to > 5 cm. Of 24 men with an initial diameter of 4.1-5.0 cm, 6 enlarged to > 5 cm. Some 69 (2%) patients were referred to hospital requiring a total of 125 consultations (1.8 consultations per patient); 21 underwent surgery and one died from rupture whilst awaiting surgery. Five patients refused their operation and two failed to attend the clinic (all > 5 cm) but remain well to date. No patient died following surgery. We conclude that, screening for AAA in men at age 65 years within an urban setting is feasible and well received by patients and GPs. Screening does not lead to a huge increase in terms of outpatient appointments and operations for AAA.
Aged↗
Case presentation: resolution of an oral lesion as a result of orofacial myofunctional therapy.
This case presentation examines the etiology, evaluation and treatment of a 57 year-old-female presenting with an area of irritation/chronic lesion on the anterior lingual surface. Orthodontic history and lingual and labial postures are discussed.
Bruxism↗
Rectal cancer and inflammatory bowel disease: natural history and implications for radiation therapy.
PURPOSE: There exists little information concerning the natural history of rectal cancer in patients with inflammatory bowel disease (IBD). In addition, the tolerance of pelvic irradiation in these patients is unknown. We analyzed the largest series of patients with IBD and rectal cancer in order to determine the natural history of the disease as well as the effect and tolerance of pelvic irradiation. METHODS AND MATERIALS: A retrospective analysis of 47 patients with IBD and rectal cancer treated over a 34-year period (1960-1994) was performed. Thirty-five patients had ulcerative colitis and 12 patients had Crohn's disease. There were 31 male patients and 16 female patients. The stage (AJC) distribution was as follows: stage 0 in 5 patients, stage I in 13 patients, stage II in 7 patients, stage III in 13 patients, and stage IV in 9 patients. Surgical resection was performed in 44 patients. In two of these patients, preoperative pelvic irradiation was given followed by surgery. Twenty of these patients underwent postoperative adjuvant therapy (12 were treated with chemotherapy and pelvic irradiation and 8 with chemotherapy alone). Three patients were found to have unresectable disease and were treated with chemotherapy alone (2 patients) or chemotherapy and radiation therapy (RT) (1 patient). Radiation complications were graded using the RTOG acute and late effects scoring criteria. Follow-up ranged from 4 to 250 months (median 24 months). RESULTS: The 5-year actuarial results revealed an overall survival (OS) of 42%, a disease-free survival (DFS) of 43%, a pelvic control rate (PC) of 67% and a freedom from distant failure (FFDF) of 47%. DFS decreased with increasing T stage with a 5-year rate of 86% for patients with Tis-T2 disease compared to 10% for patients with T3-T4 disease (p < 0.0001). The presence of lymph node metastases also resulted in a decrease in DFS with a 5-year rate of 67% for patients with NO disease compared to 0% for patients with N1-N3 disease (p < 0.0001). DFS decreased with increasing histopathologic grade with 5-year DFS rates of 71%, 52%, and 24% for grades 1, 2, and 3 respectively (p = 0.03). The T and N stages showed a statistically significant effect on pelvic control, with 5-year PC rates of 60% for Tis-2 versus 26% for T3-4 (p = 0.002) and 79% for NO versus 51% for N1-3 (p = 0.007). The histopathologic grade of the tumor did not significantly affect pelvic control. An analysis of high-risk patients (30) with T3-T4 or N1-N3 disease revealed at 5 years an OS of 9%, a DFS of 10%, a PC rate of 26%, and FFDF of 20%. In this subset of patients, there was a trend toward improved pelvic control in patients receiving RT (14 patients) with a 5-year PC of 60% compared to a rate of 23% for those patients not irradiated (16 patients). Acute complications (grade 3 or >) were noted in three patients (20%) receiving pelvic irradiation +/- chemotherapy and these included two cases of grade 3 skin reactions and one case of grade 4 gastrointestinal toxicity. Two patients (13%) developed small bowel obstruction at 2 and 4 months, respectively, postirradiation which were managed conservatively. There were no long-term complications in patients irradiated. CONCLUSION: Treatment results are comparable to those historically reported for non-IBD-related rectal cancer although the subset of high-risk patients appeared to have a poorer outcome. In light of this finding and the ability of these patients to tolerate chemotherapy and pelvic irradiation, aggressive adjuvant therapy should be given to IBD-associated rectal cancer patients with high-risk features.
Adolescent↗
Impaired T cell proliferation in acute dengue infection.
Decreased proliferative responses to mitogens and recall Ags have been observed in PBMC obtained during several acute human viral infections. To determine whether cell-mediated responses are altered during acute dengue infection, we examined the proliferative responses of PBMC from children enrolled in a prospective study of dengue infections in Thailand. All responses of PBMC during acute illness were compared with the same patients' PBMC obtained at least 6 mo after their infection. Proliferative responses to PHA, anti-CD3, tetanus toxoid, and dengue Ags were decreased significantly in PBMC obtained during the acute infection. The proliferative responses to PHA were restored by the addition of gamma-irradiated autologous convalescent or allogeneic PBMC. Cell contact with the irradiated PBMC was necessary to restore proliferation. Non-T cells from the acute PBMC of dengue patients did not support proliferation of T cells from control donors in response to PHA, but T cells from the PBMC of patients with acute dengue proliferated if accessory cells from a control donor were present. Addition of anti-CD28 Abs restored anti-CD3-induced proliferation of the PBMC of some patients. The percentage of monocytes was reduced in the acute sample of PBMC of the dengue patients. Addition of IL-2 or IL-7, but not IL-4 or IL-12, also restored proliferation of acute PBMC stimulated with anti-CD3. The results demonstrate that both quantitative and qualitative defects in the accessory cell population during acute dengue illness result in a depression of in vitro T cell proliferation.
Acute Disease↗