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1.
BMC Health Serv Res ; 23(1): 1184, 2023 Oct 31.
Article in English | MEDLINE | ID: mdl-37907903

ABSTRACT

BACKGROUND: Many people living with cancer are admitted as an emergency, some just prior to diagnosis and others in their last year of life. Factors associated with accessing emergency care for people dying of cancer are complex and not well understood. This can make it difficult to have the resources and staffing in place to best care for individuals in their last year of life and their families. METHODS: This study uses routinely collected administrative data from people who died of cancer in N. Ireland (NI) during 2015 and explores how personal characteristics (e.g., gender, age) and disease related factors (e.g., tumour site, cancer stage at initial diagnosis) were associated with having an emergency admission to hospital in the last year and the last 28 days of their lives, using multivariate logistic regression. RESULTS: Almost three in four people had at least one emergency admission in the last year of life, and over one in three had an emergency admission the last 28 days of life. Patterns were similar for both time outcomes with males, people with haematological, lung or brain cancers, younger persons, those diagnosed with late-stage cancer, and people diagnosed close to time of death, being significantly more likely to have an emergency admission. While there was no significant association between deprivation and emergency admission rates, those living in urban areas were more likely to have an emergency admission in their last month of life compared to rural dwellers. Late diagnosis was evident with 538 people (12.8% of all deaths from cancer) being diagnosed within one month of death and 1242 (29%) within 3 months of death. CONCLUSION: The high level of emergency admissions points to gaps in routine end-of-life care, and the need for additional training for hospital staff including frontline emergency department (ED) staff who are often the 'gatekeepers' to emergency inpatient care for people living with cancer. The levels of late diagnosis indicate a need for increased population awareness of cancer symptoms and system change to promote earlier diagnosis.


Subject(s)
Neoplasms , Terminal Care , Humans , Male , Emergency Service, Hospital , Hospitalization , Neoplasms/therapy , Northern Ireland/epidemiology , Retrospective Studies , Female
2.
Sex Health ; 20(5): 475-477, 2023 10.
Article in English | MEDLINE | ID: mdl-37599505

ABSTRACT

This study examined the impact of a pathway between a sexual assault service and a public sexual health service developed to improve rates of post-sexual assault medical follow-up. Follow-up attendances improved in the first 12months of the pathway (2014) compared with attendances in 2013 (17.8%vs 9.6%, P =0.01). Factors independently associated with attendance at follow-up were being prescribed HIV post-exposure prophylaxis and knowing the assailant. Those with physical injuries were less likely to attend. The prevalence of sexually transmissible infections in this cohort, 8% at the acute presentation and 5% at follow-up, suggests a need for alternatives to clinic-based follow-up.


Subject(s)
Sex Offenses , Humans , Cross-Sectional Studies , Retrospective Studies , Follow-Up Studies , Sexual Behavior
3.
BJOG ; 129(5): 796-803, 2022 Apr.
Article in English | MEDLINE | ID: mdl-34800331

ABSTRACT

OBJECTIVE: To determine the characteristics and outcomes of pregnancy in women with Turner syndrome. DESIGN: Retrospective 20-year cohort study (2000-20). SETTING: Sixteen tertiary referral maternity units in the UK. POPULATION OR SAMPLE: A total of 81 women with Turner syndrome who became pregnant. METHODS: Retrospective chart analysis. MAIN OUTCOME MEASURES: Mode of conception, pregnancy outcomes. RESULTS: We obtained data on 127 pregnancies in 81 women with a Turner phenotype. All non-spontaneous pregnancies (54/127; 42.5%) were by egg donation. Only 9/31 (29%) pregnancies in women with karyotype 45,X were spontaneous, compared with 53/66 (80.3%) pregnancies in women with mosaic karyotype 45,X/46,XX (P < 0.0001). Women with mosaic karyotype 45,X/46,XX were younger at first pregnancy by 5.5-8.5 years compared with other Turner syndrome karyotype groups (P < 0.001), and more likely to have a spontaneous menarche (75.8% versus 50% or less, P = 0.008). There were 17 miscarriages, three terminations of pregnancy, two stillbirths and 105 live births. Two women had aortic dissection (2.5%); both were 45,X karyotype with bicuspid aortic valves and ovum donation pregnancies, one died. Another woman had an aortic root replacement within 6 months of delivery. Ten of 106 (9.4%) births with gestational age data were preterm and 22/96 (22.9%) singleton infants with birthweight/gestational age data weighed less than the tenth centile. The caesarean section rate was 72/107 (67.3%). In only 73/127 (57.4%) pregnancies was there documentation of cardiovascular imaging within the 24 months before conceiving. CONCLUSIONS: Pregnancy in women with Turner syndrome is associated with major maternal cardiovascular risks; these women deserve thorough cardiovascular assessment and counselling before assisted or spontaneous pregnancy managed by a specialist team. TWEETABLE ABSTRACT: Pregnancy in women with Turner syndrome is associated with an increased risk of aortic dissection.


Subject(s)
Turner Syndrome , Cesarean Section , Cohort Studies , Female , Humans , Pregnancy , Pregnancy Outcome/epidemiology , Retrospective Studies , Turner Syndrome/complications , Turner Syndrome/epidemiology , Turner Syndrome/genetics , United Kingdom/epidemiology
4.
Oecologia ; 197(3): 771-784, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34626271

ABSTRACT

Coastal eutrophication is an issue of serious global concern and although nutrient subsidies can enhance primary productivity of coastal wetlands, they can be detrimental to their long-term maintenance. By supplying nutrients to coastal ecosystems at levels comparable to intensive agriculture practices, roosting colonial waterbirds provide a natural experimental design to examine the impacts of anthropogenic nutrient enrichment in these systems. We tested the hypothesis that long-term nutrient enrichment from bird guano deposition is linked to declines in island size, which may subsequently decrease the stability and resilience of mangrove cays in Belize. We combined remote sensing analysis with field- and lab-based measurements of forest structure, sediment nutrients, and porewater nutrients on three pairs of rookery and control cays in northern, central, and southern Belize. Our results indicate that rookery cays are disappearing approximately 13 times faster than cays without seasonal or resident seabird populations. Rookery cays were associated with a significantly higher concentration of nitrogen (N) in mangrove leaves and greater aboveground biomass, suggesting that eutrophication from bird guano contributes to increased aboveground productivity. Sediments of rookery cays also had lower percentages of soil organic matter and total N and carbon (C) than control islands, which suggests that eutrophication accelerates organic matter decomposition resulting in lower total C stocks on rookery cays. Our results indicate that coastal eutrophication can reduce ecosystem stability by contributing to accelerated cay loss, with potential consequences for mangrove resilience to environmental variability under contemporary and future climatic scenarios.


Subject(s)
Ecosystem , Wetlands , Animals , Belize , Birds , Nutrients
5.
Colorectal Dis ; 22(3): 254-260, 2020 03.
Article in English | MEDLINE | ID: mdl-31556190

ABSTRACT

AIM: The main aim of this study was to examine the effectiveness of rectoscopy for detecting local recurrence of rectal cancer in patients following low anterior resection. METHOD: This was a retrospective study of 201 patients, who underwent low anterior resection for rectal or rectosigmoid cancer between 2007 and 2009 and who were followed up with rigid rectoscopy and imaging. A total of 91 patients were excluded from the analysis for various reasons, leaving 110 patients eligible for analysis. RESULTS: A total of 613 rectoscopies were performed, and 48 biopsies taken. Six local recurrences were detected in the 110 patients, three of which were first detected by rectoscopy and three by CT. Two of the local recurrences were detected outside the follow-up programme because of symptoms: one by rectoscopy and one by CT. Three of 613 (0.5%) rectoscopies led to detection of local recurrence. The sensitivity and specificity of rectoscopy to detect local recurrence was 0.50 and 0.93, respectively. Nineteen distant metastases were detected, and two patients had both local recurrence and distant metastasis. All local recurrences and distant metastases were detected within 48Ā months of surgery. CONCLUSION: Rigid rectoscopy is poor at detecting local recurrence. Only 3 out of 613 rectoscopies (0.5%) detected local recurrence. Due to extramural growth of some recurrences, the sensitivity is also very low. Based on our results, routine rectoscopy in the surveillance of asymptomatic patients cannot be recommended.


Subject(s)
Proctectomy , Rectal Neoplasms , Follow-Up Studies , Humans , Neoplasm Recurrence, Local/diagnostic imaging , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/surgery , Retrospective Studies
6.
Ultrasound Obstet Gynecol ; 54(6): 780-785, 2019 Dec.
Article in English | MEDLINE | ID: mdl-30908816

ABSTRACT

OBJECTIVES: To describe fetal echocardiographic findings associated with lower urinary tract obstruction (LUTO) and to compare anatomic and hemodynamic measurements between fetuses with LUTO and gestational age (GA)-matched controls, with an emphasis on quantitative indices of diastolic function and cardiac output. METHODS: This was a retrospective cohort study of fetuses diagnosed with severe LUTO with giant bladder, which underwent at least one fetal echocardiogram at our center between January 2005 and June 2018. Fetuses with major congenital heart disease were excluded. Control fetuses did not have any structural or functional abnormalities and were GA-matched to the LUTO fetuses based on the time of the first fetal echocardiogram. Cardiac anatomy and hemodynamic measurements were compared between fetuses with LUTO and controls. In infants with LUTO, serial fetal and postnatal echocardiographic data were assessed, when available, and clinical outcomes were reviewed. RESULTS: Twenty-six fetuses with LUTO and at least one fetal echocardiogram available were identified, one of which was excluded due to hypoplastic left heart syndrome, leaving 25 LUTO fetuses in the final cohort. The mean GA at the first fetal echocardiogram was 25.4 Ā± 5.1 weeks in the LUTO group and 25.3 Ā± 5.0 weeks in the control group. Common findings in fetuses with LUTO included cardiomegaly (40%), pericardial effusion (44%), right ventricular (RV) hypertrophy (64%) and left ventricular (LV) hypertrophy (48%). Compared with GA-matched controls, LUTO fetuses had lower ascending aorta Z-score (-0.10 Ā± 0.94 vs -0.93 Ā± 1.03; P = 0.02) and aortic isthmus Z-score (-0.14 Ā± 0.86 vs -1.62 Ā± 1.11; P < 0.001), shorter mitral valve inflow time indexed to cardiac cycle length (0.46 Ā± 0.04 vs 0.41 Ā± 0.06; P = 0.002), and worse (increased) LV myocardial performance index (0.39 Ā± 0.03 vs 0.44 Ā± 0.04; P < 0.001). In addition, the ratio of RV to LV cardiac index was higher in LUTO fetuses compared with controls (1.62 Ā± 0.13 vs 1.33 Ā± 0.11; P < 0.001). Of the 25 LUTO pregnancies, two were lost to follow-up, three underwent elective termination of pregnancy and three ended in intrauterine fetal demise. Four (16%) patients had mildly hypoplastic left-heart structures, comprising two with aortic arch hypoplasia and two with mitral and aortic stenosis. CONCLUSION: In addition to presenting with cardiomegaly, pericardial effusion and ventricular hypertrophy, fetuses with LUTO demonstrate LV diastolic dysfunction and appear to redistribute cardiac output as compared to control fetuses, which may contribute to the development of left-heart hypoplasia. Copyright Ā© 2019 ISUOG. Published by John Wiley & Sons Ltd.


Subject(s)
Fetal Diseases/diagnostic imaging , Fetal Heart/diagnostic imaging , Lower Urinary Tract Symptoms/complications , Lower Urinary Tract Symptoms/physiopathology , Urethral Obstruction/complications , Abortion, Induced/statistics & numerical data , Adult , Aorta/abnormalities , Aorta/diagnostic imaging , Aorta/physiopathology , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/physiopathology , Cardiac Output/physiology , Cardiomegaly/epidemiology , Cardiomegaly/physiopathology , Echocardiography/methods , Female , Fetal Death , Fetal Diseases/physiopathology , Fetal Heart/physiology , Gestational Age , Hemodynamics/physiology , Humans , Hypertrophy, Left Ventricular/epidemiology , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Right Ventricular/epidemiology , Hypertrophy, Right Ventricular/physiopathology , Hypoplastic Left Heart Syndrome/epidemiology , Hypoplastic Left Heart Syndrome/physiopathology , Lower Urinary Tract Symptoms/embryology , Mitral Valve/abnormalities , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Pericardial Effusion/epidemiology , Pericardial Effusion/physiopathology , Pregnancy , Retrospective Studies , Ultrasonography, Prenatal/methods , Urethral Obstruction/diagnostic imaging , Urethral Obstruction/embryology , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/physiopathology
7.
Ultrasound Obstet Gynecol ; 51(1): 150-155, 2018 01.
Article in English | MEDLINE | ID: mdl-29297616

ABSTRACT

Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound in Medicine assembled a multi-Society Task Force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency-assessment tools were developed based on existing national and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were generated, the pass score was established at or close to 75% for each, and obtaining a set of five ultrasound images with pass score in each was deemed necessary for attaining each competency. Given the current lack of substantial data on competency assessment in ultrasound training, the Task Force expects that the criteria set forth in this document will evolve with time. The Task Force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency-assessment process. Incorporating this training curriculum and the competency-assessment tools may promote consistency in training and competency assessment, thus enhancing the performance and diagnostic accuracy of ultrasound examination in obstetrics and gynecology. Copyright Ā© 2018 ISUOG. Published by John Wiley & Sons Ltd.


Subject(s)
Clinical Competence/standards , Gynecology/education , Obstetrics/education , Ultrasonography , Accreditation , Consensus , Curriculum , Gynecology/standards , Humans , Internship and Residency , Obstetrics/standards , Quality Assurance, Health Care , Ultrasonography/standards
9.
Int J Sports Med ; 36(2): 113-9, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25329429

ABSTRACT

We investigated the influence of hypoxia on the asymptote (critical power, CP) and the curvature constant (W') of the hyperbolic power-duration relationship, as measured by both conventional and all-out testing procedures. 13 females completed 5 constant-power prediction trials and a 3-min all-out test to estimate CP and W', in both normoxia (N) and moderate hypoxia (H; FiO2=0.13). CP was significantly reduced in hypoxia compared to normoxia when estimated by conventional (H:132Ā±17 vs. N:175Ā±25 W; P<0.001) and all-out methods (H:134Ā±23 vs. N:172Ā±30 W; P<0.01). The W' was not significantly different in hypoxia compared to normoxia when established by conventional (H:12.3Ā±2.7 vs. N:13.2Ā±2.2 kJ) and all-out methods (H:12.0Ā±2.6 vs. N:12.5Ā±1.4 kJ). Estimates of CP and W' obtained with conventional and all-out methods were not significantly different either in normoxia or hypoxia. There was a significant relationship between the % change in CP relative to VƌĀ‡(O2peak) and the % change in W' in normoxia compared to hypoxia (r=0.83, P<0.001; conventional test). Changes in the W' in hypoxia are related to changes in the CP relative to VƌĀ‡(O2peak), suggesting that the W' may not be defined simply as an 'anaerobic' energy store.


Subject(s)
Exercise Tolerance/physiology , Hypoxia/physiopathology , Adult , Bicycling/physiology , Female , Humans , Muscle, Skeletal/metabolism , Oxygen Consumption , Young Adult
11.
Prenat Diagn ; 33(1): 95-101, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23225162

ABSTRACT

OBJECTIVE: To determine the sensitivity and specificity of circulating cell-free fetal DNA in determining the fetal RHD status and fetal sex. METHODS: Maternal blood was collected in each trimester of pregnancy from RhD negative nonalloimmunized women. Whole blood was centrifuged, separated into plasma and buffy coat, and frozen at -80Ā°C. DNA analysis was conducted via allele-specific primer extensions for exons 4, 5, and 7 of the RHD gene and for a 37-base pair insertion in exon 4 (RHD pseudogene; psi) three Y-chromosome sequences (SRY, DBY, and TTY2), and an extraction control (TGIFL-like X/Y). RhD serotyping on cord blood and gender assessment of the newborns were entered into a Web-based database. RESULTS: One hundred twenty women were enrolled. The median gestational age at the first venipuncture was 12.4 (range: 10.6-13.9) weeks with 120 samples drawn; 118 samples were drawn at 17.6 (16-20.9) weeks; and 113 samples at 28.7 (27.9-33.9) weeks. Overall accuracy for RHD was 99.1%, 99.1%, and 98.1% for each trimester and was 99.1%, 99.1%, and 100% for fetal sex determination. CONCLUSIONS: Fetal RHD genotyping and sex can be very accurately determined in all three trimesters using circulating cell-free fetal DNA in the maternal circulation.


Subject(s)
Blood Grouping and Crossmatching/methods , DNA/blood , Fetal Blood , Rh-Hr Blood-Group System/blood , Sex Determination Analysis/methods , Female , Genes, sry/genetics , Genotype , Gestational Age , Humans , Male , Pregnancy , Rh-Hr Blood-Group System/genetics , Sensitivity and Specificity
12.
J Laryngol Otol ; 137(3): 319-322, 2023 Mar.
Article in English | MEDLINE | ID: mdl-35465858

ABSTRACT

OBJECTIVE: Infectious mononucleosis is a relatively common acute presentation to the ENT department. There is an expected derangement in the liver function test results in most patients. There is no guidance regarding follow up, and practice varies. This study aimed to evaluate the utility of liver function tests and abdominal ultrasound in infectious mononucleosis. METHODS: This was a retrospective study of all adult patients admitted under ENT with infectious mononucleosis over a five-year period. RESULTS: A total of 153 patients were included; 80 per cent had abnormal liver function test results at presentation. Around 50 per cent had at least one liver function test assessment following discharge. Median (interquartile range) time to resolution of liver function test results was 32 days (20-50 days); maximum time was 10 months. Six patients had in-patient abdominal ultrasound: all showed a normal liver and biliary tree. No patient developed any liver disease sequelae. CONCLUSION: The findings suggest that serial assessment of liver function is not required in immunocompetent adults with subclinical derangement in liver function.


Subject(s)
Infectious Mononucleosis , Adult , Humans , Infectious Mononucleosis/complications , Infectious Mononucleosis/diagnosis , Retrospective Studies , Follow-Up Studies , Disease Progression , Liver/diagnostic imaging
13.
Ultrasound Obstet Gynecol ; 39(6): 648-53, 2012 Jun.
Article in English | MEDLINE | ID: mdl-21898637

ABSTRACT

OBJECTIVES: Polyhydramnios is present in approximately 2% of pregnancies and has been associated with a variety of adverse pregnancy outcomes. Our aim was to evaluate the association between the maximal amniotic fluid index (AFI) and the frequency of specific adverse outcomes. METHODS: This was a retrospective chart review of 524 singleton pregnancies diagnosed with polyhydramnios and delivered in a single tertiary referral center between 2003 and 2008. Polyhydramnios was defined as either AFI ≥ 25 cm or a maximum vertical pocket (MVP) ≥ 8 cm even in the presence of AFI < 25 cm. The cohort was stratified into four groups based on the maximal AFI noted during the pregnancy: < 25 cm but with MVP ≥ 8 cm; 25-29.9 cm; 30-34.9 cm; and ≥ 35 cm. Data were collected to determine the frequency of the following adverse pregnancy outcomes: prenatally diagnosed congenital anomalies, fetal aneuploidy, preterm delivery, Cesarean delivery, low birth weight, 5-min Apgar score < 7 and perinatal mortality. RESULTS: Higher AFI was associated with a statistically significant increase in the frequency of adverse pregnancy outcomes. The most severe form of polyhydramnios, as based on the maximal AFI (≥ 35 cm; n = 67), was associated with the highest rates of prenatally diagnosed congenital anomalies (79%), preterm delivery (46%), small-for-gestational-age neonate (16%), aneuploidy (13%) and perinatal mortality (27%). No significant association between degree of polyhydramnios and adverse outcome was demonstrated in cases of idiopathic polyhydramnios (n = 253). CONCLUSIONS: There is an association between the frequencies of a variety of adverse pregnancy outcomes and the severity of polyhydramnios as reflected by the maximal AFI.


Subject(s)
Amniotic Fluid , Down Syndrome/diagnosis , Polyhydramnios/diagnosis , Trisomy/diagnosis , Adolescent , Adult , Analysis of Variance , Cesarean Section , Chromosomes, Human, Pair 18 , Cohort Studies , Down Syndrome/mortality , Down Syndrome/pathology , Female , Fetal Death , Humans , Infant, Newborn , Infant, Premature , Male , Medical Records , Middle Aged , Polyhydramnios/mortality , Pregnancy , Pregnancy Outcome , Premature Birth , Prognosis , Retrospective Studies , Young Adult
14.
JPRAS Open ; 33: 145-154, 2022 Sep.
Article in English | MEDLINE | ID: mdl-35928808

ABSTRACT

Objective: To compare the symmetry of the lip following Rotation-Advancement cleft lip repair by Millard and Pigott and to investigate the effect on the symmetry of cleft side and gender by using different surgical protocols. Symmetry following cleft surgery was compared to that of non-cleft children. Design: Retrospective study of photographs of children aged 5 years. Setting: Three decades of post-operative photographs of children treated by Millard and Pigott. Patients: Eighty-nine children treated by Millard, 87 by Pigott and 91 non-cleft children. Interventions: Photographs were assessed using the Symnose Computer program, a rapid semi-objective quantitative assessment of lip symmetry. Main Outcome Measures: Asymmetry score for each surgeon, and non-cleft children. Results: There was no significant difference in the median lip % mismatch score of Millard, 36.65% and Pigott, 38.52%. Right-sided clefts showed better symmetry than left-sided clefts for Millard (p<.001). This was reversed for Pigott (P=.0121). There was a difference (P<.001) between the symmetry of the two cleft cohorts and the non-cleft children (asymmetry 19.9%), and between Millard's outcomes following different lip surgical protocols (P < .0001), but no difference between Pigott's outcomes using different palate surgical protocols (PĀ =Ā 0.59). Conclusions: Cleft lip repair by Millard and Pigott resulted in similar lip asymmetry (37% and 39% symmetry mismatch, respectively). Lip surgical protocol and cleft side may affect lip asymmetry. Palate surgery did not affect lip asymmetry. Following cleft surgery, children were more asymmetric than non-cleft children.

15.
J Neonatal Perinatal Med ; 15(1): 105-111, 2022.
Article in English | MEDLINE | ID: mdl-34459416

ABSTRACT

BACKGROUND: A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a "vanishing" CLM. OBJECTIVE: The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of "vanishing" lesions treated at our institution. METHODS: We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher's exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS: Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION: Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.


Subject(s)
Lung , Respiratory System Abnormalities , Female , Humans , Incidence , Infant, Newborn , Lung/diagnostic imaging , Pregnancy , Retrospective Studies , Ultrasonography, Prenatal
16.
J Exp Med ; 166(2): 506-19, 1987 Aug 01.
Article in English | MEDLINE | ID: mdl-3496418

ABSTRACT

Sepharose-anti-Ig and purified populations of small, high-density B cells have been used to study the formation and function of B lymphoblasts. Sepharose-anti-Ig converts small, Ia-poor B cells with a high-buoyant density to large, Ia-rich, B blasts with a low-buoyant density. We find that this response proceeds efficiently in the absence of IL-4 (BSF-1) as well as most T cells, macrophages, and dendritic cells. Further development of the blasts requires an additional stimulus, such as LPS or the conditioned medium of stimulated EL-4 thymoma cells. Within 6 h, blasts begin to enter S phase and within 24 h most divide. At later times (48-72 h) most of the blasts are actively secreting IgM. Recombinant IL-1, -2, -3, and -4 have little or no effect on the B blasts, and a neutralizing mAb to IL-4 does not block the response to EL-4 Sn. We conclude that Sepharose-anti-Ig induces B cell blastogenesis in a T-independent fashion and that these blasts represent a highly enriched population of cells that respond to distinct, T cell-derived lymphokines.


Subject(s)
Antibodies, Anti-Idiotypic/pharmacology , T-Lymphocytes/immunology , Animals , Antibodies, Monoclonal , Antibody Formation , B-Lymphocytes/immunology , Cell Division , Female , Growth Substances/pharmacology , Interleukin-1/pharmacology , Interleukin-4 , Lymphokines/pharmacology , Mice , Mice, Inbred Strains
17.
West Indian Med J ; 59(1): 88-91, 2010 Jan.
Article in English | MEDLINE | ID: mdl-20931922

ABSTRACT

In just over 20 years, laparoscopic cholecystectomy has emerged as the standard therapy for cholelithiasis and is now being performed with increased safety. However an uncommon complication of this technique has been jaundice even in patients without iatrogenic bile duct injury. We report on two cases where this complication occurred and review the literature on this topic.


Subject(s)
Cholecystectomy, Laparoscopic , Cholelithiasis/surgery , Jaundice/etiology , Postoperative Complications/etiology , Adult , Female , Humans , Jaundice/therapy , Liver Function Tests , Postoperative Complications/therapy
18.
Gene Ther ; 16(3): 367-75, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19129860

ABSTRACT

A replication-incompetent adenoviral vector encoding the heavy chain C-fragment (H(C)50) of botulinum neurotoxin type C (BoNT/C) was evaluated as a mucosal vaccine against botulism in a mouse model. Single intranasal inoculation of the adenoviral vector elicited a high level of H(C)50-specific IgG, IgG1 and IgG2a in sera and IgA in mucosal secretions as early as 2 weeks after vaccination. The antigen-specific serum antibodies were maintained at a high level at least until the 27th week. Immune sera showed high potency in neutralizing BoNT/C as indicated by in vitro toxin neutralization assay. The mice receiving single dose of 2 x 10(7) p.f.u. (plaque-forming unit) of adenoviral vector were completely protected against challenge with up to 10(4) x MLD(50) of BoNT/C. The protective immunity showed vaccine dose dependence from 10(5) to 2 x 10(7) p.f.u. of adenoviral vector. In addition, animals receiving single intranasal dose of 2 x 10(7) p.f.u. adenoviral vector could be protected against 100 x MLD(50) 27 weeks after vaccination. Animals with preexisting immunity to adenovirus could also be vaccinated intranasally and protected against lethal challenge with BoNT/C. These results suggest that the adenoviral vector is a highly effective gene-based mucosal vaccine against botulism.


Subject(s)
Bacterial Vaccines/immunology , Botulinum Toxins/immunology , Botulism/prevention & control , Adenoviridae/genetics , Animals , Antibodies, Bacterial/biosynthesis , Botulism/immunology , Dose-Response Relationship, Immunologic , Enzyme-Linked Immunosorbent Assay/methods , Female , Genetic Vectors , Immunity, Mucosal , Mice , Mice, Inbred BALB C , Vaccination/methods , Vaccines, Synthetic/immunology
19.
J Cell Biol ; 37(3): 660-82, 1968 Jun.
Article in English | MEDLINE | ID: mdl-11905199

ABSTRACT

The loss of kinetoplast DNA in Leishmania tarentolae, which occurs in the presence of low concentrations of acriflavin, was found to be a result of selective inhibition of replication of this DNA. Nuclear DNA synthesis was relatively unaffected and cell and kinetoplast division proceeded normally for several generations. An approximately equal distribution of parental kinetoplast DNA between daughter kinetoplasts resulted in a decrease in the average amount of DNA per kinetoplast. The final disappearance of the stainable kinetoplast DNA occurred at a cell division in which all the remaining visible kinetoplast DNA was retained by one of the daughter cells. The selective inhibition of kinetoplast DNA synthesis was caused by a selective localization of acriflavin in the kinetoplast. The apparent intracellular localization of dye and the extent of uptake at a low dye concentration could be manipulated, respectively, by varying the hemin (or protoporphyrin IX) concentration in the medium and by adding red blood cell extract (or hemoglobin). Hemin and protoporphyrin IX were found to form a complex with acriflavin. During growth in acriflavin, cells exhibited an increasing impairment of colony-forming ability and rate of respiration. No change in the electrophoretic pattern of total cell soluble proteins was apparent. The data fit the working hypothesis that the loss of kinetoplast DNA leads to a respiratory defect which then leads to a decrease in biosynthetic reactions and eventual cell death. A possible use of the selective localization of acriflavin in the kinetoplast to photooxidize selectively the kinetoplast DNA is suggested.


Subject(s)
Acriflavine/pharmacology , DNA, Kinetoplast/drug effects , Fluorescent Dyes/pharmacology , Leishmania/metabolism , Animals , Autoradiography , Cell Culture Techniques/methods , Cell Nucleus/metabolism , Centrifugation, Density Gradient , Cesium/pharmacology , Chlorides/pharmacology , DNA/analysis , DNA/biosynthesis , DNA/drug effects , Electrophoresis , Erythrocytes/parasitology , Hemin/pharmacology , Kinetics , Microscopy, Fluorescence , Mutation , Proflavine/pharmacology , Time Factors
20.
Science ; 153(3735): 548, 1966 Jul 29.
Article in English | MEDLINE | ID: mdl-17830373

ABSTRACT

Sterile disposable filter units made of Nalgene contain an impurity which inhibits the growth of the protozoan, Leishmania tarentolae, in a defined medium.

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