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Demography of DSM-III borderline personality disorder (PD): a comparison with Axis II PDs, affective illness and schizophrenia convergent and discriminant validation.

Demographic characteristics of borderline personality disorder (PD) defined according to DSM-III criteria were compared with those found for schizophrenia, affective illness, and other Axis II PDs. Borderline PD, unlike affective illness and most other Axis II PDs, usually occurs before the age of 30. By contrast to antisocial PD and schizophrenia, borderline PD usually occurs after the age of 25. For borderline PD (N = 280) average age was significantly more homogeneous compared with affective illness (N = 157) and Axis II PDs (N = 71) across 9 studies. By contrast, variability for 63 predominantly male schizophrenics in 3 studies was significantly less, reflecting the younger age at admission compared with borderline PD (N = 84). According to predictions based upon an age-of-risk hypothesis (Dahl, 1985) for 106 borderline PD patients, a significantly lower percentage were > or = 40 years of age than diagnostic controls (N = 181) predominantly with DSM-III affective illness. Borderline PD is predominantly diagnosed in females either single or who have been divorced compared with Axis II PDs and affective illness, to a lesser extent. Unlike antisocial PD, as well as schizophrenia, the preponderance of male and single/divorced patients usually occur significantly less than for borderline PD. Borderline PD usually occur significantly less than Axis II PDs, affective illness and schizophrenia and ethnic minorities, particularly Afro-Americans. These differences in ethnic/racial distribution are explained in terms of two hypotheses. From the perspective of demographic variables, borderline PD closely converges with neither (a) schizophrenia, (b) antisocial PC, (c) other Axis II PDs, nor (d) affective illness. Evidence for discriminant and convergent validation of these data is provided by (a) cluster analyses and intersample pairwise contrasts, as well as comparisons with (b) clinical samples selected on the basis of DSM-III-R and criteria of the (c) Diagnostic Interview for Borderline Patients, (d) a longitudinal case registry study conducted in Denmark, and (e) prospective surveys conducted among (i) North Carolina community residents and (ii) first degree (nonpatients) relatives of psychiatric patients in Iowa.

Adult↗

Subcuticular skin closure following minor breast biopsy: Prolene is superior to polydioxanone (PDS)

The aim of this study was to determine whether a subcuticular absorbable suture (polydioxanone acid, PDS, Ethicon, UK) was superior to a subcuticular non-absorbable suture (Prolene, Ethicon, UK) for day-case breast biopsy performed under local anaesthesia. After breast biopsy, the type of subcuticular suture to be used was randomized in 100 patients. In all other respects the surgery and written postoperative instructions were similar for the group. Patients were reviewed over two visits by one independent observer who was unaware of the suture utilized (median 10 days and 52 days after surgery). Three patients had incomplete documentation and four patients failed to attend for either visit: thus 47 and 46 patients in the Prolene and PDS groups, respectively, were assessed. There was no difference between the Prolene and PDS groups, respectively, in the median interval to either the first shower or removal of the original plaster. There were three wound infections (one with Prolene, two with PDS). At the first visit three patients in the Prolene group had their incision uncovered, compared to 20 patients in the PDS group. In the PDS group a buried knot eroded through the incision in eight patients (17%). In this study the expected advantages of an absorbable suture were not confirmed.

Adult↗

A randomised comparison of polydioxanone (PDS) and polypropylene (Prolene) for abdominal wound closure.

Two hundred and eighty four patients undergoing laparotomy by vertical incision were randomly allocated to closure with interrupted mass sutures of No. 1 polydioxanone (PDS) or No. 1 polypropylene (Prolene). Dehiscence occurred in 0.7% of the PDS group but in 6.4% of the Prolene group (P = 0.018). Wound infection occurred in 8.6% of the PDS group and 15.4% of the Prolene group (P = 0.1). One hundred and ninety patients attended for review at a minimum of one year. Incisional herniation, usually asymptomatic, was present in 11% of each group. Knots were palpable in 2% of the PDS patients but in 12% of the Prolene: wound pain occurred in 12% of the PDS group but in 23% of the Prolene group (P = 0.06). These results suggest that PDS may be useful for abdominal closure.

Abdomen↗

Splice-site mutation in the PDS gene may result in intrafamilial variability for deafness in Pendred syndrome.

Pendred syndrome is a recessive inherited disorder that consists of developmental abnormalities of the cochlea, sensorineural hearing loss, and diffuse thyroid enlargement (goiter). This disorder may account for up to 10% of cases of hereditary deafness. The disease gene (PDS) has been mapped to chromosome 7q22-q31, and encodes a chloride-iodide transport protein. We performed mutation analysis of individual exons of the PDS gene in one Spanish family that shows intrafamilial variability of the deafness phenotype (two patients with profound and one with moderate-severe deafness). We identified a new splice-site mutation affecting intron 4 of the PDS gene, at nucleotide position 639+7. RNA analysis from lymphocytes of the affected patients showed that mutation 639+7A-->G generates a new donor splice site, leading to an mRNA with an insertion of six nucleotides from intron 4 of PDS. Since the newly created donor splice site is likely to compete with the normal one, variations of the levels of normal and aberrant transcripts of the PDS gene in the cochlea may explain the variability in the deafness presentation.

Amino Acid Sequence↗

[Maxon and PDS--evaluation and physical and biologic properties of monofilament absorbable suture materials].

The physical parameters of monofilament absorbable sutures (Maxon and PDS) were studied. Compared to PDS Maxon proved somewhat more unwieldy, however, it required less complicated knot combinations for a secure placement than PDS did. In vivo experiments on rats showed a slight tissue reaction and a dissolution time of 120-180 days for Maxon and 180-240 days for PDS. With Maxon, tensile strength was measurable for 42-49 days, while the period for PDS amounted to 65-80 days. New indications for these materials are discussed, two parameters, easy knot formation and atraumatic passage through the tissue, especially favor the use of Maxon for one-row all-layer sutures in the gastrointestinal tract.

Animals↗

Predeposit self-transfusion (PDS) in a hepatobiliopancreatic surgery (HBPS) unit: preliminary data.

Hepatobiliary pancreatic surgery (HBPS) has high morbility and mortality and frequently requires blood transfusion. Allogeneic transfusion may cause adverse sequelae. Predeposit self-transfusiOn (PDS) minimizes allogeneic blood transfusion and avoids most adverse reactions. We present the preliminary data of our PDS experience (with recombinant human erythropoieting, r-HuEPO) in HBPS during the first year. We studied our first-year HBPS-PDS program by a retrospective review of the case histories and transfusion records in our Blood Bank. Sex, weight, underlying disease, packed red cell units (PRCUs) requested, drawn, and transfused, and hospital and ICU stays were analyzed. Nine patients were admitted in the PDS program. Of desired blood units, 83% was obtained, successfully in 77.8% of patients, and 63.2% were transfused with autologous blood transfusion. Only three patients needed allogeneic blood (33.3%). All complications occurred in patients who received allogeneic units. Also, we found stays were three times longer in those patients. PDS could be a valid and safe alternative for patients undergoing elective HBPS because it decreases allogeneic blood requirements, reduces overall complications, and also reduces hospital and ICU stays.

Adolescent↗

Molecular analysis of the PDS gene in a nonconsanguineous Sicilian family with Pendred's syndrome.

OBJECTIVE: The autosomal recessive Pendred's syndrome is defined by congenital sensorineural deafness, goiter, and impaired iodide organification. It is caused by mutations in the Pendred's syndrome (PDS) gene that encodes pendrin, a chloride/iodide transporter expressed in the thyroid, the inner ear, and the kidney. In this study we performed clinical and molecular analyses in three siblings from a nonconsanguineous Sicilian family who presented with the clinical features of Pendred's syndrome. PATIENTS AND MOLECULAR ANALYSES: In two sisters and one brother, the clinical diagnosis of Pendred's syndrome was established based on the findings of sensorineural hearing loss and large goiters. Thyroid function tests, perchlorate discharge tests, thyroid ultrasound, and scintigraphy were performed in all affected individuals. Exons 2 to 21 of the PDS gene were amplified by polymerase chain reaction (PCR) and both strands were submitted to direct sequence analysis. RESULTS: The clinical diagnosis of Pendred's syndrome was supported by a positive perchlorate discharge test in the three afflicted siblings. Direct sequence analysis of the PDS gene revealed that all three harbored one allele with a novel mutation 890delC leading to a frameshift mutation and premature stop codon at position 302 (FS297 > 302X). On the other allele, two of the siblings had a previously described transition 1226G > A, which results in the substitution of arginine by histidine at position 409 (R409H). In the index patient, no mutation could be identified on the other allele. In functional studies, these mutants lose the ability of pendrin to mediate iodide efflux. CONCLUSIONS: All three patients included in this study presented with the classic Pendred syndrome triad. Two siblings were compound heterozygous for mutations in the coding region of the PDS gene. The third individual could have an unidentified mutation in a regulatory or intronic region of the PDS gene, or an identical phenotype caused by distinct pathogenic mechanisms.

Adolescent↗

Functional differences of the PDS gene product are associated with phenotypic variation in patients with Pendred syndrome and non-syndromic hearing loss (DFNB4).

The PDS gene encodes a transmembrane protein, known as pendrin, which functions as a transporter of iodide and chloride. Mutations in this gene are responsible for Pendred syndrome and autosomal recessive non-syndromic hearing loss at the DFNB4 locus on chromosome 7q31. A screen of 20 individuals from the midwestern USA with non-syndromic hearing loss and dilated vestibular aqueducts identified three people (15%) with PDS mutations. To determine whether PDS mutations in individuals with Pendred syndrome differ functionally from PDS mutations in individuals with non-syndromic hearing loss, we compared three common Pendred syndrome allele variants (L236P, T416P and E384G), with three PDS mutations reported only in individuals with non-syndromic hearing loss (V480D, V653A and I490L/G497S). The mutations associated with Pendred syndrome have complete loss of pendrin-induced chloride and iodide transport, while alleles unique to people with DFNB4 are able to transport both iodide and chloride, albeit at a much lower level than wild-type pendrin. We hypothesize that this residual level of anion transport is sufficient to eliminate or postpone the onset of goiter in individuals with DFNB4. We propose a model for pendrin function in the thyroid in which pendrin transports iodide across the apical membrane of the thyrocyte into the colloid space.

Alleles↗

Enlarged vestibular aqueduct: a radiological marker of pendred syndrome, and mutation of the PDS gene.

Although the textbook view of Pendred syndrome is that of an autosomal recessive condition characterized by deafness and goitre, it is increasingly clear that not all such patients present this classical clinical picture. Malformations of the inner ear, specifically enlargement of the vestibular aqueduct, are common in Pendred syndrome and mutations in the PDS (Pendred Syndrome) gene have been recorded in patients presenting with deafness and vestibular aqueduct dilatation only, without other features of Pendred syndrome. Since this is the most common radiological malformation of the cochlea in deaf patients, we investigated what proportion of such cases were due to mutation of the PDS gene. We assessed 57 patients referred with radiological evidence of vestibular aqueduct enlargement, by history, clinical examination, perchlorate discharge test and molecular analysis of the PDS locus. Forty-one patients (72%) had unequivocal evidence of Pendred syndrome. The finding of a single heterozygous mutation at the PDS gene in a further eight was strongly suggestive of a critical role for pendrin, the protein product of the PDS gene, in the generation of enlarged vestibular aqueducts in at least 86% (49/57 cases) of patients with this radiological malformation. Securing the diagnosis of Pendred syndrome may be difficult, especially in the single case. Goitre is an inconstant finding, and the perchlorate discharge test, although helpful, is of diagnostic value only if abnormal. Enlargement of the vestibular aqueduct should be considered as the most likely presentation of Pendred syndrome and should prompt specific investigation of that diagnostic possibility. Pendred syndrome might henceforth be recharacterized as deafness with enlargement of the vestibular aqueduct, which is sometimes associated with goitre.

Adolescent↗

Mutations in the PDS gene in German families with Pendred's syndrome: V138F is a founder mutation.

Pendred's syndrome, an autosomal-recessive condition characterized by congenital sensorineural hearing loss and goiter, is caused by mutations in the PDS gene. Located on chromosome 7q22-q31, it encodes a chloride-iodide transporter expressed in the thyroid, inner ear, and kidney. We investigated the PDS gene of six affected individuals from four unrelated families with Pendred's syndrome by direct sequencing. PDS mutations were identified in homozygous or compound heterozygous state in all six cases. A homozygous missense mutation leading to the amino acid substitution S133T was detected in a family of Turkish origin. The mutations found in the other affected individuals, who originate from Germany, were V138F/Y530H, V138F/E384G, and V138F/V138F. Because V138F was found in the German patients with Pendred's syndrome on at least one allele, we genotyped five microsatellite markers located in the PDS region. All affected German individuals shared a common haplotype at three microsatellite markers located close to or within the PDS gene. We therefore concluded that V138F is a founder mutation in our cohort of German families with Pendred's syndrome.

Adolescent↗

[Stabilization of the injured shoulder joint with PDS cord].

A successful treatment of the acromioclavicular separation is the repair of the acromioclavicular and coracoclavicular (CC-)ligaments and a stable reduction of the acromioclavicular (AC-)joint. To avoid dangerous breakage and migration of the K-wire an abduction humeral splint is necessary immobilizing the injured shoulder for 5-6 weeks. In the years 1987-1989 40 patients suffering AC-separation were treated (34 Tossy III separations, 4 Tossy II separations, 2 Tossy I separations). In these cases a stable reduction was achieved by a transarticular K-wire fixation and a combination of AC- and CC-fixation by loops. In 1987 wire loop was used. In 1988 a combination of wire and Polydioxanon (PDS) loops was used. The PDS-loop, a slowly resorbable suture material, fixed the CC-ligament. In 1989 the AC-joint was stabilized by a PDS-loop as well. The examination of 31 patients 6-24 months after the operation showed good clinical results no matter whether PDS-loops or wire loops were used. The advantage of the transarticular K-wire fixation in combination with PDS-loops was the easy removal, which could be done in mostly of the cases as an outpatient procedure. An operation of the AC-Tossy III separation on patients beyond their 4. decade should be well considered. A long time of treatment, remaining pain and a limitation of shoulder movement must be expected.

Acromioclavicular Joint↗

Coenzyme dependent suppression of 2,2-PDS induced contractures in Spirostomum.

Spirostomum ambiguum was stimulated to contract by addition of the thiol inhibitor, 2,2-dithiobispyridine (PDS), which depletes intracellular reducing equivalents which are generated by coenzyme dependents reactions. PDS induced contractures were not suppressed after 2--4 h of pre-incubation in a medium enriched with ascorbic acid, thiamine, or riboflavin, singly. Two h of incubation with nicotinamide did not suppress contractures; however, 50% suppression occurred after 3 h incubation. Incubation of the cells in a medium enriched with all four coenzymes for up to 4 h, resulted in the suppression of PDS induced contractures to a level as low as 30% of control values. Suppression of contractures by the mixed coenzymes was concentration dependent. Cells that were stimulated with PDS and contracting, exhibited a 50% suppression of contractures within 3 min after transfer to a complementary medium enriched with mixed coenzymes. These results suggest that coenzymes interact synergistically with cellular metabolic processes to inhibit pharmacodynamic responses to PDS.

2,2'-Dipyridyl↗

Absorbable PDS-II suture and nonabsorbable polypropylene suture in aortic anastomoses in growing piglets.

The long-term outcome of vascular anastomoses in children can be compromised by stenosis when the growth of the anastomosis does not match that of the vessels. This can be influenced by the suture material. We evaluated the suitability of the new generation of polydioxanone (PDS-II), an absorbable synthetic monofilament suture, in vascular surgery, in terms of permitting normal growth of aortic anastomoses. Ten piglets underwent primary end-to-end anastomosis of the thoracic aorta, five with PDS-II suture and five with conventional polypropylene (Prolene) suture. Six months after surgery, an aortogram was obtained for each animal. The piglets were then killed and the aortas were sent for pathologic examination. Complete absorption of suture material with slight dilatation of the anastomoses was found in all five pigs in the PDS-II suture group. We also found thrombus formation in one pig in this group. Mild stenosis of the anastomotic site was noted in all five pigs in the polypropylene suture group, but no intraluminal thrombus formation was seen. The degree of dilatation or stenosis within each group was not significantly different when intraluminal diameters were compared at three distinct sites in the reconstructed aorta (p > 0.05). The differences in vascular growth between the two groups were also not significant (p > 0.05). Histologic examination revealed less tissue reaction in the PDS-II suture group than in the polypropylene suture group. Thus, PDS-II seems to be a suitable suture material for anastomoses as far as vascular growth is concerned, but the possibility of aneurysm formation secondary to dilatation of the anastomotic site should be kept in mind.

Anastomosis, Surgical↗

Microsurgical use of polydioxanone (PDS) suture: an experimental report.

Although many technological advances have been made in surgical materials, nylon is still the main suture material use for microvascular surgery. This study sought to evaluate polydioxanone (PDS) sutures for use in microvascular anastomoses. Twenty-eight male Sprague-Dawley rats were used in this experiment. Spatula-type needles with 9-0 PDS suture were used to anastomose the right femoral arteries, with 9-0 nylon used on the left side. The arteries were observed for 1, 2, 3, 4, 8, 12, and 16 weeks after surgery to determine arterial patency and to evaluate vascular pathology. Results were comparable between PDS and nylon. We suggest that if the suture material is redesigned to allow smooth passage through the tissue, and if the needle used in conjunction with the suture is improved, PDS may offer an excellent material for microvascular anastomosis.

Anastomosis, Surgical↗

Cloning and characterization of the gene for phytoene desaturase (Pds) from tomato (Lycopersicon esculentum).

The gene Pds encodes phytoene desaturase, a key enzyme in carotenoid biosynthesis that converts phytoene to zeta-carotene. We have cloned and analyzed the genomic DNA sequence of Pds from tomato. In tomato Pds is comprised of 15 exons that, together with the introns occupy over 8 kb. A putative promoter sequence has been identified by comparison with the cDNA sequence of Pds. A consensus nucleotide sequence around intron splicing sites in tomato genes was determined by compiling data on 137 introns in 34 genes. This consensus sequence generally agrees with the consensus sequence of other higher plants with only minor differences that are unique to tomato.

Amino Acid Sequence↗

A biomechanical comparison of the Mitek RapidLoc, Mitek Meniscal repair system, clearfix screws and vertical PDS and Ti-Cron sutures.

The aim of this in vitro study was to measure and compare the biomechanical properties and mode of failure of the five different methods of meniscal repair. Reproducible tears were created in 50 bovine medial menisci and repaired in a standardized fashion with one of the following devices: the RapidLoc meniscal repair device (Mitek Products, Westwood, MA), an 8 mm Mitek meniscal repair system (Mitek Products, Westwood, MA), Clearfix screw (Innovasive Devices, Marlborough, MA), a single vertical mattress suture of 2-0 Ti-Cron (Ethicon, Massachusetts) and a vertical mattress suture of No. 1 PDS II (Johnson and Johnson Int.). The repairs were tested by single cycle load to failure in a materials testing machine. The mean loads to failure for each of the repair groups were as follows: Mitek RapidLoc 44.9 N, Mitek meniscal repair system 20.3 N, Clearfix screw 37.4 N, vertical Ti-Cron 66.1 N and vertical PDS suture 103.0 N. The mean load to failure was significantly greater with PDS vertical sutures than with other techniques (P<0.05). The Mitek RapidLoc had the least extension at failure (14.8 mm) (P<0.05). This study confirms meniscal repair with vertical PDS sutures confers the highest biomechanical stability and that the new Mitek RapidLoc device offers improved load to failure than the previous generations.

Absorbable Implants↗

A pressure-distribution sensor (PDS) for evaluation of lip functions.

The purpose of this study was to develop and to test a pressure-distribution sensor (PDS) for evaluating lip functions. The PDS is fabricated as a disposable cartridge and is based on the principle of optical-pressure conversion used in tactile sensors of robot arms. Its advantages are in measuring sealing forces, contact area, and pressure-distribution patterns of the lips at maximum effort. We used the PDS to evaluate pressure-distribution patterns of long-face subjects with extremely large interlabial distances. The results suggest that the PDS is a useful device for evaluating lip sealing functions and their changes after orthodontic therapy or orthognathic surgery.

Disposable Equipment↗

A qualitative analysis of the planning, implementation and management of a PDS scheme: lessons for local commissioning of dental services.

AIM: To identify the experiences of primary care trust employees, the dental teams and other key individuals of the planning, implementation and management of a Personal Dental Services scheme. METHOD: A thematic analysis of a series of qualitative interviews with 29 individuals who were involved in the planning, implementation and management of a PDS scheme in South East London. FINDINGS: Nine key themes were analysed from the data. For each theme perspectives could be identified for both the employees of the primary care trusts and the dental team. These perspectives differ in key respects. CONCLUSIONS: Practitioners value the PDS scheme and consider it a positive experience. They suggest that it has led to an increase in quality of care, and a more professional management approach to the practice. The practice team felt that they have benefited from an enhanced working environment. The main concern expressed was that patient registrations were not being accurately assessed. Those involved in the management of the PDS scheme, while endorsing local commissioning arrangements, were concerned that it was not known whether PDS was meeting local needs. There was little quality benchmarking, which would have allowed robust measure of success. The contract model and outcomes should have been more sensitively designed. There was concern expressed that the small number of practices who participated in the pilot scheme prohibits the possibility of thoroughly analysing the impact of local commissioning. Future local commissioning should identify mechanisms for ensuring the effective planning, management and evaluation of the impact of the schemes. A core element of this will be the specification of appropriate goals for commissioning.

Attitude of Health Personnel↗