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Biomedical subjects

T Smith

Publications and source records attributed to T Smith.

At least 325 records · Page 18Linked to original sources
PubMed1997

Extreme attitudes to body shape, social and psychological factors and a reluctance to breast feed. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

Despite widespread advocacy of breast feeding, many babies are breast fed only briefly, if at all. Mothers' decisions on how to feed are often made before the birth; so we have sought demographic, social and psychological factors that might be amenable to intervention during pregnancy. In the Avon Longitudinal Study of Pregnancy and Childhood about 12,000 women completed questionnaires in pregnancy. Univariate analyses were carried out to establish which factors were related to breast feeding intentions. All significant factors in univariate analyses were entered into logistic regression analyses. Demographic characteristics independently related to intentions to breast feed included older maternal age, more maternal education, primiparity and not smoking; in previous work all these had been associated with actual feeding behaviour. Social relationship variables had a small influence. Of the psychological variables, a notable finding was that women who were preoccupied with their body shape and those who expressed controlling, less child-centred, responses to managing an infant in the postnatal months were less likely to express intentions to breast feed. Depression did not predict breast feeding intentions once the other factors had been taken into account. Health care professionals may be able to intervene to increase breast feeding by making routine enquiries during antenatal care and targeting appropriate subgroups.

Adolescent↗
PubMed1997

Seizure resulting from a venlafaxine overdose.

OBJECTIVE: To report a case of venlafaxine overdose. CASE SUMMARY: A 40-year-old woman with major depression took an overdose of venlafaxine in an apparent suicide attempt. After the ingestion of 26 venlafaxine 50-mg tablets, the patient experienced a witnessed generalized seizure. She was admitted to the medical intensive care unit, venlafaxine was discontinued, and no further sequelae were seen. DISCUSSION: To our knowledge, this is the first reported case of venlafaxine overdose that resulted in a generalized seizure. Based on nonoverdose pharmacokinetics and pharmacodynamics of venlafaxine and the potential risks of available interventions, no emergent therapy was instituted. CONCLUSIONS: The venlafaxine overdose in our patient resulted in a single episode of generalized seizure but elicited no further sequelae.

Adult↗
PubMed1997

Intensive behavioral treatment for preschoolers with severe mental retardation and pervasive developmental disorder.

From archival records, we assessed outcomes achieved by preschoolers with both severe mental retardation and autistic features: (a) an experimental group (n = 11), which received intensive behavioral treatment, and (b) a comparison group (n = 10), which received minimal treatment. At intake (mean CA = 3.08 years), the groups did not differ significantly on any variable. At follow-up children in the experimental group obtained a higher mean IQ and evinced more expressive speech than did those in the comparison group. Behavior problems diminished in both groups. Results indicate that intensively treated children achieved clinically meaningful gains relative to the comparison group but remained quite delayed.

Autistic Disorder↗
PubMed1997

Müllerian mixed tumors: CT characteristics with clinical and pathologic observations.

OBJECTIVE: This retrospective study analyzed the CT characteristics of mullerian mixed tumors. Clinical aspects, outcomes, and pathologic correlations were also evaluated. CONCLUSION: Müllerian mixed tumor is a rapidly growing aggressive tumor with a relatively poor prognosis. Uterine and metastatic masses showed central low attenuation. Metastatic masses often had irregular enhancement centrally and surface enhancement circumferentially. The tendency toward local and lymphatic spread and intraperitoneal seeding was greater than the tendency toward hematogenous metastases. CT was useful before surgery in defining the extent of disease and for follow-up clinical management in identifying metastases and assessing treatment effectiveness.

Aged↗
PubMed1997

Primary parotid lymphoma: the effect of International Prognostic Index on outcome.

Since the reported survival and failure-free survival (FFS) of adults with primary parotid non-Hodgkin's lymphoma (NHL) is variable, we reviewed our experience of untreated adults with primary parotid NHL. Patients were eligible if they presented to the University of Texas M. D. Anderson Cancer Center Cancer between 1980 and 1995 with parotid enlargement and if the diagnosis of lymphoma was verified according the Working Formulation. Medical records were reviewed to determine Ann Arbor Stage (AAS), the International Prognostic Index (IPI) score, response to therapy, relapse, FFS, and survival. We identified 39 untreated adults with primary parotid NHL representing 1% of all lymphomas and 8.6% of all untreated parotid neoplasms. Three patients were excluded because of suboptimal therapy, leaving 36 patients eligible for outcome analysis. Of the 18 patients with low-grade NHL, two were treated with radiotherapy, eight with chemotherapy and radiotherapy, seven with chemotherapy only, and one with antibiotics. The complete remission (CR) rate was 94%, and with a median follow-up of 36 months for surviving patients the survival and failure-free survival (FFS) at 5 years were 94% and 78%, respectively. The 5-year FFS were not statistically different between patients with early (I or II) or advanced (III or IV) AAS (83% and 74%, respectively; p > 0.05) and favorable (0 or 1) or unfavorable (> 1) IPI scores (73% and 100%, respectively; p > 0.05). All 18 patients with intermediate-grade NHL were treated with doxorubicin-based chemotherapy which was followed by radiotherapy in six. The CR rate was 89%, and with a median follow-up of 51 months for surviving patients the survival and FFS at 10 years were 80% and 72%, respectively. In this group 10-year FFS was better in early than in advanced AAS (100% vs 0%, respectively; p = 0.01) and in favorable (0 or 1) than in unfavorable (> 1) IPI scores (86% vs 20%, respectively; p < 0.01). We conclude the the FFS of patients with low-grade NHL is 78% and not affected by AAS or IPI score. The FFS of patients with intermediate-grade NHL appears comparable with that of NHLs of other primary sites, being 86% for those with IPI < or = 1 and 20% for those with IPI 1. Patients with IPI > 1 should be entered on investigational protocols aiming to increase FFS.

Adult↗
PubMed1997

Interleukin-12 induces relapse in experimental allergic encephalomyelitis in the Lewis rat.

Acute, monophasic experimental allergic encephalomyelitis (EAE) in the Lewis rat shows pathological similarities to the human disease multiple sclerosis (MS). Rats that recover from EAE are essentially resistant to disease reinduction, unlike MS in which relapses are frequently associated with common bacterial and viral infections. As macrophage-derived interleukin (IL)-12 is a critical component of innate resistance to bacterial infection and appears to directly activate encephalitogenic T cells in vivo, the ability of this cytokine to reinduce paralysis in EAE was examined. Paralytic disease was exacerbated by intraperitoneal IL-12 administration and could be reinduced up to 1 week after recovery from the primary clinical episode. Concomitant with worsening of initial clinical signs and relapse was an increase in the ratio of macrophages to T cells in brain stem perivascular cuffs and the expression of inducible nitric oxide synthase in cells with both macrophage and microglial morphology. These findings suggest that IL-12 may contribute to macrophage-mediated disease exacerbation and relapse in patients with MS.

Animals↗
PubMed1997

Assessing family planning service-delivery skills in Kenya.

This report demonstrates the use of Lot Quality Assurance Sampling (LQAS) to evaluate the technical competence of two cohorts of family planning service providers in Kenya trained with a new curriculum. One cohort had just finished training within two months of the study. The other cohort was the first group trained with the new curriculum about one year before the study. LQAS was adapted from industrial and other public health applications to assess both the individual competence of 30 service providers and the competence of each cohort. Results show that Cohorts One and Two did not differ markedly in the number of tasks needing improvement. However, both cohorts exhibited more tasks needing improvement in counseling skills as compared with physical examination skills or with all other skills. Care-givers who were not currently providing services accounted for most service-delivery problems. This result suggests that providers' use of their skills explains their ability to retain service-delivery skills learned in training to a greater degree than does the amount of time elapsed since they were trained. LQAS proved to be a rapid, easy-to-use empirical method for management decisionmaking for improvement of a family planning training curriculum and services.

Chi-Square Distribution↗
PubMed1997

Interferon-alpha neutralizing antibodies in HIV and chronic HCV patients treated with natural-source human leukocyte-derived interferon-alpha n3.

Human leukocyte-derived IFN-alpha n3 (Alferon N Injection) was administered subcutaneously to treat 20 patients with asymptomatic human immunodeficiency virus type 1 (HIV-1) and 141 patients with chronic hepatitis C virus (HCV) infections. The treatment of HIV-1 and HCV patients, previously untreated with any IFN preparations, did not result in development of neutralizing antibodies to IFN-alpha n3. Among 69 HCV refractory patients who were unresponsive to previous treatment with rIFN-alpha 2b, 2 had neutralizing antibodies to rIFN-alpha 2b prior to IFN-alpha n3 therapy, with no or limited cross-reactivity to IFN-alpha n3. After retreatment with IFN-alpha n3, both patients had detectable neutralizing titers to IFN-alpha n3. Additionally, 2 other patients developed low and transient neutralizing titers to IFN-alpha n3. Interferon subtype specificity of these antibodies was tested against RP-HPLC purified fractions of IFN-alpha n3, as well as rIFN-alpha 2b and rIFN-alpha 8b. Sera from patients previously treated with rIFN-alpha 2b with high antibody titers to rIFN-alpha 2b strongly reacted with the natural IFN-alpha 2b, and to a limited extent with other iFN-alpha subtypes. Neutralizing activity against IFN-alpha 2b was significantly competed out by the presence of a small amount of other interferon subtypes present in IFN-alpha n3. One patient with prior presence of antibodies to IFN-alpha 2b developed a high antibody titer to IFN-alpha 8b with limited reactivity to IFN-alpha n3. Two of the HCV refractory patients with prior neutralizing antibodies to rIFN-alpha 2b responded to IFN-alpha n3 therapy. These data suggest that the presence of neutralizing antibodies to individual IFN-alpha species will not significantly diminish the biological activity and the clinical efficacy of multi-species IFN-alpha n3.

Antibodies↗
PubMed1997

Publishing workshops number 4. Preparing a manuscript: reviewing literature.

In this paper we have looked at the different avenues for nurses to contribute to the knowledge base of the discipline by writing about nursing literature. We emphasised the responsibility that goes with this action. As with all writing the starting point is for the author to define the boundaries of the work, and then decide what it is that she or he wants to communicate. After that it is a matter of planning a logical and coherent sequence and proceeding to develop the content in language that is as simple and effective as possible. Reference was made to the general guidelines for writing proposed in an earlier workshop (Chick et al, 1996). In this paper three different forms, a review article, a literature review and review of a piece of literature have been discussed, noting the purposes that each serves and the way in which, to a large extent, purpose dictates both content and the order and priority to be given to the various sections. Three of the key dimensions along which variation can occur are scope, critical emphasis, and relevance to practice.

Humans↗
PubMed1997

A comparison of double-cuffed with single-cuffed Tenckhoff catheters in the prevention of infection in pediatric patients.

Double-cuffed peritoneal catheters (DCCs) may be more effective at preventing penetrating infection than single-cuffed catheters (SCCs). The aim of this study was to see whether DCCs conferred any benefit in the pediatric population. Twenty consecutive SCCs inserted for chronic dialysis were compared with 20 subsequent DCCs. All catheters were inserted by a single operator (MAL). Outcome was assessed by the number of exit-site infections (ESIs) and episodes of peritonitis. There was no difference in the age or sex distribution of the groups, both having 50% of patients under 5 years. The SCCs were followed for 106 patient-months (1 still in situ) and the DCCs for 145 patient-months (11 still in situ). Peritonitis-related catheter loss was significantly more common with SCCs (9 vs 1, p < 0.01). S. aureus was a significantly more common cause of peritonitis in SCCs (10 vs 3, p < 0.03), although almost all ESIs were with this organism. The relative risk of S. aureus peritonitis with a SCC compared to a DCC was 2.077 (95% confidence interval, CI, 1.17-3.69), and the relative risk of catheter loss with peritonitis was 7.5 for SCCs (95% CI 1.14-49.6). In conclusion, double-cuffed peritoneal catheters are more effective than single-cuffed catheters in preventing penetrating infection in infants and children.

Adolescent↗
PubMed1997

Porcine aromatases: studies on tissue-specific, functionally distinct isozymes from a single gene?

Aromatase cytochrome P450 (P450arom) is expressed in a variety of tissues. Pigs express P450arom as bilaminar blastocysts in utero, and thereafter in the gonads, adrenal glands and placenta. Our studies also demonstrate the existence of porcine isozymes of P450arom which differ substantially in their amino acid composition and function. The placental isoform, most similar to P450arom in other mammals, consists of 503 amino acids. The ovarian isoform, expressed in both theca and granulosa cells, is a 501 amino acid protein exhibiting less than 20% of the activity of the placental isozyme. Furthermore, it is inhibited not only by CGS16949A but also by etomidate which does not inhibit the placental P450arom. Partial sequences generated by the rapid amplification of the cDNA ends (RACE) procedure indicate that the expression of a third isoform in the blastocyst is switched to the placental isozyme during differentiation of the fetal membranes. In addition, these transcripts, and others from the theca, granulosa, testes, adrenal glands and placenta demonstrate differences in the 5'-untranslated region (putative exon I) suggestive of tissue-specific alternative splicing. An identical 5'-untranslated sequence was obtained from transcripts expressed in the theca and granulosa. Testes and adrenal transcripts also have identical 5' ends, which differ substantially from the ovarian sequence. Blastocyst and placenta 5'-untranslated sequences differ from each other and from those expressed in the gonads and adrenals. Several tissue-specific transcripts thus encode porcine P450arom. Interestingly, distinct 5' sequences exist for ovarian and testes P450arom mRNAs, suggesting different promoters and therefore regulation in the male and female gonads. The molecular origins of the functional isoforms and the tissue-specific transcripts are uncertain, however partial genomic sequence and other genetic analyses suggest the existence of multiple genes. However, sequence alignment of the placental and ovarian isoforms indicates complete conservation of putative exon III, so that complex splicing remains a possibility. Clearly, the regulation of P450arom expression is more complex in the pig than in other vertebrates investigated to date.

Amino Acid Sequence↗
PubMed1997

Regulation of the inflammatory response in animal models of multiple sclerosis by interleukin-12.

Interleukin 12 (IL-12), a novel heterodimeric protein produced primarily by antigen-presenting cells, serves as a key regulator of innate and adaptive immune responses. In addition to being a potent inducer of IFN-gamma, IL-12 is widely considered to be the principal cytokine that regulates the generation of Th1 type effector cells. As the successful induction of experimental autoimmune encephalomyelitis (EAE) is associated with a strong Th1 type cellular response, we have evaluated the role of IL-12 in regulating the pathogenesis of EAE in SJL/J mice and Lewis rats. In both settings, treatment with IL-12 was found to accelerate the onset and increase the severity and duration of clinical disease. More importantly, administration of IL-12 to Lewis rats that had recovered from primary disease was found to trigger clinical relapse. In all instances, IL-12-induced exacerbation was associated with a profound increase in iNOS positive macrophages within the perivascular lesions. Although IL-12-induced IFN-gamma does not appear to be required for exacerbation of disease, neutralizing antibodies against murine IL-12 delay the onset and reduce the severity of adoptively transferred EAE, indicating a role for endogenous IL-12 as regulator of disease. Based on the above findings, effective inhibition of IL-12 in vivo may have great therapeutic value in the treatment of MS and other Th1-associated inflammatory disorders.

Adoptive Transfer↗