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Butchart A, Peden M, Matzopoulos R, Phillips R, Burrows S, Bhagwandin N, Saayman G, Cooper A. The South African National Non-Natural Mortality Surveillance System--rationale, pilot results and evaluation. S Afr Med J 2001; 91:408-17. [PMID: 11455806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND While individual mortuaries have recorded data for non-natural deaths in time-limited studies, there have been no systematic efforts to draw forensic-medical services and state mortuaries into a nationwide fatal injury surveillance system. Beginning in June 1998, the National Non-Natural Mortality Surveillance System (NMSS) commenced pilot operation. OBJECTIVE To evaluate the NMSS and illustrate its utility from sample findings. DESIGN Data entered into the system by mortuary staff were checked against a random sample of cases for which separate forms were completed by an independent researcher. Process observations and follow-up with data users were used to assess the system's acceptability, timeliness and data usefulness. SETTING Eighteen mortuaries in six provinces representing approximately 35,000 cases per year, or around 50% of all non-natural deaths. PARTICIPANTS The National Departments of Health; Safety and Security; and Arts, Culture, Science and Technology; national and provincial forensic medico-legal services; the South African Police Services; universities and science research councils. MAIN OUTCOME MEASURES Surveillance system simplicity, flexibility, acceptability, sensitivity, positive predictive value, representativeness, timeliness, data usefulness and resources. RESULTS The NMSS was established at 10 target sites. Lack of equipment, personnel resistance, and closure of some mortuaries prevented implementation in the remaining eight mortuaries. Sensitivity was internally assessed and ranged from 65% to 95% for manner of death. Positive predictive value was also internally measured, and ranged from 74% to 80% for manner of death and from 71% to 82% for mechanism of death. Timeliness was good, and basic reports covering most items were available 6 weeks after a case had been examined. While staff found the system simple, acceptability depended on the individuals involved at different mortuaries, and the system was compromised to some extent by bureaucratic barriers. End users found the data to be of great value. NMSS set-up costs totalled approximately R26,000 per mortuary, and it is estimated that maintenance costs will be R8.00 per case registered. CONCLUSIONS With minimal resources, the NMSS uses existing investigative procedures to describe and report the epidemiology of fatal injuries. The pilot study demonstrates the feasibility of the system, and identifies the need to remove organisational constraints and individual barriers if it is to be sustained and expanded beyond the pilot sites.
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Affiliation(s)
- A Butchart
- Institute for Social and Health Sciences, University of South Africa, Pretoria
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202
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Abstract
A heuristic algorithm for enhancement of fluoroscopic images of varying contrast is proposed. The new technique aims at identifying a suitable type of enhancement for different locations in an image. The estimation relies on simple preliminary classification of image parts into one of the following types: uniform, sharp (with sufficient contrast), detail-containing (structure present) and unknown (for the cases where it is difficult to make a decision). Different smoothing techniques are applied locally in the different types of image parts. For those parts that are classified as detail-containing, probable object boundaries are identified and local sharpening is carried out to increase the contrast at these places. The adopted approach attempts to improve the quality of an image by reducing available noise and simultaneously increasing the contrast at probable object boundaries without increasing the overall dynamic range. In addition, it allows noise to be cleaned, that at some locations is stronger than the fine structure at other locations, whilst preserving the details.
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Affiliation(s)
- T O Ozanian
- Department of Computer Science, University of Hull, Hull HU6 7RX, UK
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203
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Fagan MJ, Dobson CA, Ganney PS, Sisias G, Phillips R, Langton CM. Finite Element Analysis of Simulations of Cancellous Bone Resorption. Comput Methods Biomech Biomed Engin 2001; 2:257-270. [PMID: 11264831 DOI: 10.1080/10255849908907991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A stochastic simulation of the resorption of cancellous bone has been developed and integrated with a finite element model to predict the resultant change in structural properties of bone as bone density decreases. The resorption represents the net imbalance of osteoclast and osteoblast activity that occurs in osteoporosis. A simple lattice structure of trabecular bone is considered, with an examination of the lattice geometry and discretization indicating that just five trabeculae need to be modelled. The results from the analysis show how the mechanical properties of the cancellous bone degrade with osteoporosis and demonstrate how the method can be used to predict the relationships between stiffness and density or porosity.
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Affiliation(s)
- M. J. Fagan
- School of Engineering, University of Hull, HULL, UK
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204
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Jensen DR, Gayles EC, Ammon S, Phillips R, Eckel RH. A self-correcting indirect calorimeter system for the measurement of energy balance in small animals. J Appl Physiol (1985) 2001; 90:912-8. [PMID: 11181600 DOI: 10.1152/jappl.2001.90.3.912] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Indirect calorimetry involves measurement of CO(2) produced and O(2) consumed by an organism. These measurements are then used to calculate energy output, metabolic rate (MR), and respiratory quotient (RQ), a relative assessment of carbohydrate and lipid oxidation. By far the most difficult aspect of indirect calorimetry is measurement of O(2). Moreover, the abundance of O(2) (20.95%) relative to CO(2) (0.03%) in ambient conditions dictates that measurement errors of O(2) have greater implications on calculations of MR and RQ. Because compressed air is not feasible for use with animals in long-term experiments, changes in ambient conditions are nearly unavoidable. A self-correcting indirect calorimetry system was designed and constructed utilizing differential O(2) and CO(2) analyzers and a blank cage to monitor ambient conditions periodically. The system was validated by changing ambient O(2) and CO(2) concentrations by infusing N(2) into the system during a test butane burn. MR and RQ were largely unaffected by these changes in ambient conditions, and inclusion of a blank cage in the system accounted for slight calibration offsets. MR and RQ were measured in mice (n = 95) with and without correction for any small changes in ambient conditions measured in the blank cage. Coefficients of variation for MR and RQ were significantly decreased by taking into account ambient conditions measured in the blank cage (P < 0.001), which resulted in a 2.3% increase in precision for measurement of MR. This system will be used to more accurately assess long-term measurements of energy balance in the many murine models of leanness and obesity to gain better insights into pathophysiology and treatment of human obesity.
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Affiliation(s)
- D R Jensen
- Division of Endocrinology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA
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205
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Zaidman G, Ramirez T, Kaufman A, Palay D, Phillips R, Medow N. Successful surgical rehabilitation of children with traumatic corneal laceration and cataract. Ophthalmology 2001; 108:338-42. [PMID: 11158810 DOI: 10.1016/s0161-6420(00)00524-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the visual and refractive outcome of corneal transplant surgery, cataract extraction, and intraocular lens (IOL) implantation in children with traumatic corneal laceration and cataract. DESIGN Retrospective, noncomparative case series. PARTICIPANTS Five patients, 7 years of age or younger, who underwent penetrating keratoplasty, cataract extraction, and IOL implantation for traumatic corneal laceration and cataract were identified. MAIN OUTCOME MEASURES Each case was analyzed retrospectively for the following factors: preoperative findings; surgical technique, including management of the posterior capsule; measurement of axial length and keratometry; calculation of IOL power, style, and type of IOL implanted; graft clarity; final visual acuity; and final refraction. RESULTS The five children ranged from 3 to 7 years of age at the time of trauma. All had primary repair of their injury before referral. Each patient was observed for more than 2 years. Each had a posterior chamber IOL placed in the sulcus. After surgery, no severe complications were observed. The preoperative visual acuity ranged from 20/400 to light perception. After surgery, all five patients had clear grafts and an improved visual acuity ranging from 20/20 to 20/400. The final spherical refraction in each patient was within 3.75 diopters (D) of plano, with 1.50 to 3.25 D of cylinder. CONCLUSIONS Successful surgical rehabilitation was accomplished in these patients. Despite their young age and the difficulty in determining IOL power, combining surgery and aggressive amblyopia therapy resulted in visual rehabilitation with refractions approaching emmetropia.
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Affiliation(s)
- G Zaidman
- Department of Ophthalmology, Westchester Medical Center New York Medical College, Valhalla, New York, USA
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206
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Abstract
The karyotypes of salmonid fishes including taxa in the three subfamilies Coregoninae, Thymallinae and Salmoninae are described. This review is an update of the (Hartley, 1987) review of the chromosomes of salmonid fishes. As described in the previous review, the karyotypes of salmonid fishes fall into two main categories based on chromosome numbers: the type A karyotypes have diploid numbers close to 80 with approximately 100 chromosome arms (2n = 80, NF = 100), and the type B karyotypes have diploid numbers close to 60 with approximately 100 chromosome arms (2n = 60, NF = 100). In this paper we have proposed additional sub categories based on variation in the number of chromosome arms: the A' type with NF = 110-120, the A" type with NF greater than 140, and the B' type with NF less than 80. Two modes of chromosome evolution are found in the salmonids: in the Coregoninae and the Salmoninae the chromosomes have evolved by centric fusions of the Robertsonian type decreasing chromosome numbers (2n) while retaining chromosome arm numbers (NF) close to that found in the hypothetical tetraploid ancestor so that most extant taxa have either type A or type B karyotypes. In the Thymallinae, the chromosomes have evolved by inversions so that chromosome arm numbers (NF) have increased but chromosome numbers (2n) close to the karyotype of the hypothetical tetraploid ancestor have been retained and all taxa have type A' karyotypes. Most of the taxa with type B karyotypes in the Coregoninae and Salmoninae are members of the genus Oncorhynchus, although at least one example of type B karyotypes is found in all of the other genera. These taxa either have an anadromous life history or are found in specialized lacustrine environments. Selection for increases or decreases in genetic recombination as proposed by Qumsiyeh, 1994 could have been involved in the evolution of chromosome number in salmonid fishes.
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Affiliation(s)
- R Phillips
- Department of Biological Sciences, University of Wisconsin-Milwaukee, 53201, USA
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207
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Reddy GB, Hunt PG, Phillips R, Stone K, Grubbs A. Treatment of swine wastewater in marsh-pond-marsh constructed wetlands. Water Sci Technol 2001; 44:545-550. [PMID: 11804147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Swine waste is commonly treated in the USA by flushing into an anaerobic lagoon and subsequently applying to land. This natural system type of application has been part of agricultural practice for many years. However, it is currently under scrutiny by regulators. An alternate natural system technology to treat swine wastewater may be constructed wetland. For this study we used four wetland cells (11 m width x 40 m length) with a marsh-pond-marsh design. The marsh sections were planted to cattail (Typha latifolia, L.) and bulrushes (Scirpus americanus). Two cells were loaded with 16 kg N ha(-1) day(-1) with a detention of 21 days. They removed 51% of the added N. Two additional cells were loaded with 32 kg ha(-1) day(-1) with 10.5 days detention. These cells removed only 37% of the added N. However, treatment operations included cold months in which treatment was much less efficient. Removal of N was moderately correlated with the temperature. During the warmer periods removal efficiencies were more consistent with the high removal rates reported for continuous marsh systems--often > than 70%. Phosphorus removal ranged from 30 to 45%. Aquatic macrophytes (plants and floating) assimilated about 320 and 35 kg ha(-1), respectively of N and P.
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Affiliation(s)
- G B Reddy
- Department of Natural Resources & Environmental Design, North Carolina, A&T State University, Greensboro, USA
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208
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Murray D, O'Riordan M, Geary M, Phillips R, Clarke T, McKenna P. The HELLP syndrome: maternal and perinatal outcome. Ir Med J 2001; 94:16-8. [PMID: 11322219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The HELLP syndrome is a rare condition with a variable presentation, and in general, the outlook for mother and baby is felt to be poor. The aims of this study were to determine the maternal and perinatal outcome in cases of the HELLP syndrome at the Rotunda hospital over a five-year period. A retrospective review of all cases of confirmed HELLP syndrome from 1/1/95 to 1/9/99 was undertaken. Antenatal, intrapartum and neonatal data and in particular, maternal and neonatal complications were recorded. There were 20 cases of HELLP syndrome over the 5-year period. Mean maternal age was 29.8 (19-43) years. 70% were nulliparous. 80% delivered within 24 hours of diagnosis. 85% were delivered by caesarean section. Mean gestation at delivery was 33.5 (24-41) weeks, 65% of which were preterm. 70% of the babies were admitted to the neonatal intensive care unit (NICU). Mean birth weight was 1923g (440-4640g). Mean length of stay was 23.8 (1-68) days. 40% developed respiratory distress syndrome (RDS) with a mean duration of ventilation for these infants of 2.4 (0.5-7) days. There were 2 perinatal deaths both of whom weighed <500g. 95% of women were admitted to the High Dependency Unit. There were no maternal deaths. The mean interval to resolution of laboratory indices to within normal reference ranges was 11 (2-30) days. Maternal morbidity was high, but short-term, with full resolution in all cases. Once the diagnosis was made, delivery was immediate. The neonatal morbidity was also high and was most closely related to the gestation at delivery.
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Affiliation(s)
- D Murray
- Department of Paediatrics, Rotunda Hospital, Dublin
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209
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Houlston R, Crabtree M, Phillips R, Crabtree M, Tomlinson I. Explaining differences in the severity of familial adenomatous polyposis and the search for modifier genes. Gut 2001; 48:1-5. [PMID: 11115811 PMCID: PMC1728176 DOI: 10.1136/gut.48.1.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- R Houlston
- Section of Cancer Genetics, Haddow Laboratories Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
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210
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Affiliation(s)
- W Hyer
- Department of Pediatrics, St. Mark's Hospital, Harrow, United Kingdom.
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211
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Hooper PD, Phillips R, Adams A, Allen D, Schultz GD, Scaringe J, Beckman J, Goubran E, Morganthal P, Farrar K, Traina A. Los Angeles College of Chiropractic practice model. Altern Ther Health Med 2000; 6:76-9. [PMID: 11076450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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212
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Lechner F, Gruener NH, Urbani S, Uggeri J, Santantonio T, Kammer AR, Cerny A, Phillips R, Ferrari C, Pape GR, Klenerman P. CD8+ T lymphocyte responses are induced during acute hepatitis C virus infection but are not sustained. Eur J Immunol 2000. [PMID: 11009080 DOI: 10.1002/1521-4141(200009)30:9<2479::aid-immu2479>3.0.co;2-b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cellular immune responses are likely to play a key role in determining the clinical outcome in acute infection with hepatitis C virus (HCV), but the dynamics of such responses and their relationship to viral clearance are poorly understood. In a previous study we have shown highly activated, multispecific cytotoxic T lymphocyte responses arising early and persisting in an individual who subsequently cleared the virus. In this study the HCV-specific CD8+ lymphocytes response has been similarly analyzed, using peptide-HLA class I tetramers, in a further nine individuals with documented acute HCV infection, six of whom failed to clear the virus. Significant populations of virus-specific CD8+ lymphocytes were detected at the peak of acute hepatic illness (maximally 3.5% of CD8+ lymphocytes). Frequencies were commonly lower than those seen previously and were generally not sustained. Early HCV-specific CD8+ lymphocytes showed an activated phenotype in all patients (CD38+ and HLA class II+), but this activation was short-lived. Failure to sustain sufficient numbers of activated virus-specific CD8+ lymphocytes may contribute to persistence of HCV.
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Affiliation(s)
- F Lechner
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, GB
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213
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Lechner F, Gruener NH, Urbani S, Uggeri J, Santantonio T, Kammer AR, Cerny A, Phillips R, Ferrari C, Pape GR, Klenerman P. CD8+ T lymphocyte responses are induced during acute hepatitis C virus infection but are not sustained. Eur J Immunol 2000. [PMID: 11009080 DOI: 10.1002/1521-4141(200009)30: 9<2479: : aid-immu2479>3.0.co; 2-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cellular immune responses are likely to play a key role in determining the clinical outcome in acute infection with hepatitis C virus (HCV), but the dynamics of such responses and their relationship to viral clearance are poorly understood. In a previous study we have shown highly activated, multispecific cytotoxic T lymphocyte responses arising early and persisting in an individual who subsequently cleared the virus. In this study the HCV-specific CD8+ lymphocytes response has been similarly analyzed, using peptide-HLA class I tetramers, in a further nine individuals with documented acute HCV infection, six of whom failed to clear the virus. Significant populations of virus-specific CD8+ lymphocytes were detected at the peak of acute hepatic illness (maximally 3.5% of CD8+ lymphocytes). Frequencies were commonly lower than those seen previously and were generally not sustained. Early HCV-specific CD8+ lymphocytes showed an activated phenotype in all patients (CD38+ and HLA class II+), but this activation was short-lived. Failure to sustain sufficient numbers of activated virus-specific CD8+ lymphocytes may contribute to persistence of HCV.
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Affiliation(s)
- F Lechner
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, GB
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214
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Abstract
High blood pressure, defined as systolic blood pressure of greater than 140 mmHg or diastolic blood pressure of greater than 90 mmHg affects millions of people throughout the world. A number of studies have shown that consumption of fruit, vegetables, wine and tea may protect against stroke, for which hypertension is the major risk factor. Flavonoid compounds, including flavonols, flavones and isoflavones, represent an important source of antioxidants in the diet. Flavonoid intake has been inversely associated with mortality from coronary heart disease and stroke. We hypothesize that individuals with hypertension have lower circulating flavonoid levels. Increased consumption of flavonoid-rich foods may decrease rates of hypertension. Lowering blood pressure through increased dietary consumption of dietary antioxidants may decrease the rate of end-organ damage that is secondary to hypertension.
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Affiliation(s)
- J Moline
- Division of Occupational and Environmental Medicine, Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York 10029, USA.
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215
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Phillips R, Hafez MA, Mohsen AM, Sherman KP, Hewitt JR, Browbank I, Bouazza-Marouf K. Computer and robotic assisted osteotomy around the knee. Stud Health Technol Inform 2000; 70:265-71. [PMID: 10977555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The outcome variability and failures of conventional osteotomy have been attributed to lack of preoperative planning and inaccuracy in performing the correction. We present a computer and robotic assisted surgery system that can aid in accurate surgical planning for realignment, and in precisely implementing the plan in theatre. The approach seeks to avoid the cost and risks associated with the use of CT, and the insertion of fiducial markers, which are characteristic of existing computer assisted surgical systems. The paper details the architecture of the system as a whole, placing particular emphasis on planning technique. It is anticipated that the increased accuracy possible with the system will prove particularly useful for correcting multi-plane deformities, which are more problematic with conventional techniques.
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216
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Lechner F, Gruener NH, Urbani S, Uggeri J, Santantonio T, Kammer AR, Cerny A, Phillips R, Ferrari C, Pape GR, Klenerman P. CD8+ T lymphocyte responses are induced during acute hepatitis C virus infection but are not sustained. Eur J Immunol 2000; 30:2479-87. [PMID: 11009080 DOI: 10.1002/1521-4141(200009)30:9<2479::aid-immu2479>3.0.co;2-b] [Citation(s) in RCA: 246] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cellular immune responses are likely to play a key role in determining the clinical outcome in acute infection with hepatitis C virus (HCV), but the dynamics of such responses and their relationship to viral clearance are poorly understood. In a previous study we have shown highly activated, multispecific cytotoxic T lymphocyte responses arising early and persisting in an individual who subsequently cleared the virus. In this study the HCV-specific CD8+ lymphocytes response has been similarly analyzed, using peptide-HLA class I tetramers, in a further nine individuals with documented acute HCV infection, six of whom failed to clear the virus. Significant populations of virus-specific CD8+ lymphocytes were detected at the peak of acute hepatic illness (maximally 3.5% of CD8+ lymphocytes). Frequencies were commonly lower than those seen previously and were generally not sustained. Early HCV-specific CD8+ lymphocytes showed an activated phenotype in all patients (CD38+ and HLA class II+), but this activation was short-lived. Failure to sustain sufficient numbers of activated virus-specific CD8+ lymphocytes may contribute to persistence of HCV.
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Affiliation(s)
- F Lechner
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, GB
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217
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Langton CM, Haire TJ, Ganney PS, Dobson CA, Fagan MJ, Sisias G, Phillips R. Stochastically simulated assessment of anabolic treatment following varying degrees of cancellous bone resorption. Bone 2000; 27:111-8. [PMID: 10865217 DOI: 10.1016/s8756-3282(00)00290-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the recovery in cancellous bone stiffness resulting from anabolic treatment following varying degrees of resorption, using a stochastic simulation applied to a simplistic structure consisting of five vertical and five horizontal trabeculae. The structure was initially resorbed, and "bone" elements were stochastically removed until nominal resorptions of 10%, 15%, 20%, 25%, and 30% were achieved. A stochastic simulation of anabolic treatment was then applied where bone elements were added, continuing until the original stiffness had been regained, for example, simulating treatment of a patient with an anabolic agent after a period of postmenopausal resorption. The resorption and anabolic simulations were repeated three times for each of the nominal resorptions. The stiffness of the bone structure decreased linearly with resorption, with a slope of approximately -2 and an R(2) of 97.0%; hence, the stiffness fell at approximately twice the rate of the reduction in density. When the various structures regained their original density, the resultant stiffness also had a linear relationship with the original resorption, with a slope of -1 and a lower R(2) of 86.1%. This implies that the reduction in stiffness, when original density was regained, fell proportionately with the degree of initial resorption and, therefore, after a resorption of 30%, when original density was regained, the stiffness of the resultant structure was approximately 30% less than that of the original structure. The density required for the original stiffness to be regained increased linearly with the degree of initial resorption, with a slope of approximately 0.5 and an R(2) of 65.2%, lower than that observed for the previous relationships. This indicates a greater spread of data and suggests greater variability in the formation phase beyond the point of regained original density. Because irreversible connectivity reduction is widely considered to be one of the earliest manifestations of estrogen loss, these findings, although obtained on a simulation of a simplistic cancellous bone structure, support the concept of early intervention to prevent potentially irreversible deterioration of trabecular architecture after menopause.
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Affiliation(s)
- C M Langton
- Centre for Metabolic Bone Disease, Royal Hull Hospitals Trust and University of Hull, UK.
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218
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Abstract
This paper focuses on the task of automatic feature detection for intra-operative drilling trajectory planning for computer-assisted internal fixation of hip fractures. The features of interest are the lateral cortex line of the femoral shaft, the femoral neck centre and the femoral head centre, the latter being the most challenging of all. Since the object is known, the detection process is regarded as a localisation task rather than a recognition one. Simple anatomical relationships between bone parts provide a naturally hierarchical approach to searching, allowing refinement of image-derived information based on a priori constraints. Use of knowledge and an unconventional "divide-and-conquer" approach produce more reliable and faster results than the standard global image processing routine. Analysis of summed 1D grey level profiles is used as a main segmentation tool to carry out the above strategy.
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Affiliation(s)
- T O Ozanian
- Department of Computer Science, University of Hull, UK
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219
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220
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Herbert R, Schechter C, Smith DA, Phillips R, Diamond J, Carroll S, Weiner J, Dahms TE, Landrigan PJ. Occupational coronary heart disease among bridge and tunnel officers. Arch Environ Health 2000; 55:152-63. [PMID: 10908098 DOI: 10.1080/00039890009603401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Traffic-control officers employed in New York City tunnels prior to 1981 have been at increased risk of mortality from coronary heart disease. In this study, the authors assessed current coronary heart disease prevalence and evaluated associations between coronary heart disease and occupational factors among New York City bridge and tunnel officers. A clinical cardiovascular disease surveillance and cross-sectional occupational epidemiologic study was conducted. The authors used comprehensive evaluations to identify current and prior incidences of coronary heart disease. Occupational risk factors evaluated included job strain, current and historic exposure to carbon monoxide, and occupational physical inactivity. Current carbon monoxide exposure was assessed via workshift changes in carboxyhemoglobin. Coronary heart disease occurred in 29 (5.5%) of the 526 bridge and tunnel officers examined. Risk of coronary heart disease was associated positively with total years each bridge and tunnel officer work had worked in that capacity (odds ratio = 1.64 for each decade of employment, adjusted for nonoccupational coronary heart disease risk factors). Carboxyhemoglobin levels were low in the subjects, and job strain and physical inactivity were very prevalent. Occupational factors contributed to the risk of coronary heart disease in New York City bridge and tunnel officers. The authors were unable to identify the specific factors that led to the increase in risk described.
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Affiliation(s)
- R Herbert
- Department of Community Medicine, Mount Sinai School of Medicine, New York, New York, USA
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221
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Affiliation(s)
- J Y Chen
- Department of Dermatology, Baylor College of Medicine, Hoston, Texas
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222
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Abstract
There is an increased frequency of invasive anal cancer in HIV-seropositive men. Early treatment strategies in this patient group employed reduced dosages of chemotherapy or radiotherapy alone to reduce toxicity. Since 1989 we have used combined modality treatment consisting of chemotherapy 5-fluorouracil (5-FU) and mitomycin C, and concomitant radical radiotherapy to the pelvis (38-51 Gy in 20-30 fractions), with most patients receiving a perineal boost (10-18 Gy). 12 homosexual HIV-positive men have been treated. The median CD4 count at diagnosis of anal cancer was 209 cells/microl (range: 29-380 cells/microl), 5 had prior AIDS defining diagnoses. No patients had metastatic disease. Complete remissions were obtained in 9/11 evaluable patients and in 1 further patient following surgery. 2 patients relapsed both within 6 months of diagnosis. At a median follow-up of 4.8 years (range: 0.4-10 years), 4 patients have died (2 from anal cancer, 1 from treatment-related consequences and 1 from opportunistic infection in remission). Actuarial 2-year survival is 60% (95% confidence interval (CI): 29-91%). Grade 3 haematological toxicity was recorded in 3 patients, grade 4 and 5 gastrointestinal toxicity in 1 patient each and grade 3 skin toxicity in 1 patient. Radical chemoradiation may be given safely at conventional doses in HIV-positive patients, with a high complete response rate.
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Affiliation(s)
- S Cleator
- Department of Radiotherapy, Charing Cross Hospital, Fulham Palace Road, London, UK
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Shenoy VB, Kukta RV, Phillips R. Mesoscopic analysis of structure and strength of dislocation junctions in fcc metals. Phys Rev Lett 2000; 84:1491-1494. [PMID: 11017550 DOI: 10.1103/physrevlett.84.1491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/1999] [Indexed: 05/23/2023]
Abstract
We develop a finite-element-based nodal dislocation dynamics model to simulate the structure and strength of dislocation junctions in fcc crystals. The model is based on anisotropic elasticity theory supplemented by the explicit inclusion of the separation of perfect dislocations into partial dislocations bounding a stacking fault. We demonstrate that the model reproduces in precise detail the structure of the Lomer-Cottrell lock already obtained from atomistic simulations. In light of this success, we also examine the strength of junctions culminating in a stress-strength diagram which is the locus of points in stress space corresponding to dissolution of the junction.
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Affiliation(s)
- VB Shenoy
- Division of Engineering, Brown University, Providence, Rhode Island 02912, USA
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224
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Phillips R. Wine & adulteration. Hist Today 2000; 50:31-37. [PMID: 18365357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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225
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Phillips R, Kelly KT. Practice-based or community-based smoking cessation counseling? J Fam Pract 1999; 48:941-942. [PMID: 10628573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- R Phillips
- University of Missouri Medical Center, Columbia, USA.
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226
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Phillips R, Nash M. Terbinafine and lupus erythematosus a chance association? Dermatol Online J 1999; 5:9. [PMID: 10673462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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227
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Phillips R. Paediatrics and child health. Arch Dis Child 1999; 81:460C-460. [PMID: 10519730 PMCID: PMC1718140 DOI: 10.1136/adc.81.5.460c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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228
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Bevan S, Woodford-Richens K, Rozen P, Eng C, Young J, Dunlop M, Neale K, Phillips R, Markie D, Rodriguez-Bigas M, Leggett B, Sheridan E, Hodgson S, Iwama T, Eccles D, Bodmer W, Houlston R, Tomlinson I. Screening SMAD1, SMAD2, SMAD3, and SMAD5 for germline mutations in juvenile polyposis syndrome. Gut 1999; 45:406-8. [PMID: 10446110 PMCID: PMC1727626 DOI: 10.1136/gut.45.3.406] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Juvenile polyps occur in several Mendelian disorders, whether in association with gastrointestinal cancer alone (juvenile polyposis syndrome, JPS) or as part of known syndromes (Cowden, Gorlin, and Bannayan-Zonana) in association with developmental abnormalities, dysmorphic features, or extraintestinal tumours. Recently, some JPS families were shown to harbour germline mutations in the SMAD4 (DPC4) gene, providing further evidence for the importance of the TGFbeta signalling pathway in colorectal cancer. There remains, however, considerable, unexplained genetic heterogeneity in JPS. Other members of the SMAD family are excellent candidates for JPS, especially SMAD2 (which, like SMAD4, is mutated somatically in colorectal cancers), SMAD3 (which causes colorectal cancer when "knocked out" in mice), SMAD5, and SMAD1. METHODS SMAD1, SMAD2, SMAD3, and SMAD5 were screened for germline mutations in 30 patients with JPS and without SMAD4 mutations. RESULTS No mutations were found in any of these genes. A G-A C89Y polymorphism with possible effects on protein function was found in SMAD3, but the frequencies of the G and A alleles did not differ between patients with JPS and controls. CONCLUSIONS It remains to be determined whether or not this polymorphism is involved in a minor predisposition to colorectal or other carcinomas. SMAD4 may be the only member of the SMAD family which causes JPS when mutant in the germline. The other genes underlying JPS remain to be identified.
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Affiliation(s)
- S Bevan
- Section of Cancer Genetics, Haddow Laboratories, Institute of Cancer Research, Sutton, UK
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229
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Lamlum H, Ilyas M, Rowan A, Clark S, Johnson V, Bell J, Frayling I, Efstathiou J, Pack K, Payne S, Roylance R, Gorman P, Sheer D, Neale K, Phillips R, Talbot I, Bodmer W, Tomlinson I. The type of somatic mutation at APC in familial adenomatous polyposis is determined by the site of the germline mutation: a new facet to Knudson's 'two-hit' hypothesis. Nat Med 1999; 5:1071-5. [PMID: 10470088 DOI: 10.1038/12511] [Citation(s) in RCA: 230] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
APC is often cited as a prime example of a tumor suppressor gene. Truncating germline and somatic mutations (or, infrequently, allelic loss) occur in tumors in FAP (familial adenomatous polyposis). Most sporadic colorectal cancers also have two APC mutations. Clues from attenuated polyposis, missense germline variants with mild disease and the somatic mutation cluster region (codons 1,250-1,450) indicate, however, that APC mutations might not result in simple loss of protein function. We have found that FAP patients with germline APC mutations within a small region (codons 1,194-1,392 at most) mainly show allelic loss in their colorectal adenomas, in contrast to other FAP patients, whose 'second hits' tend to occur by truncating mutations in the mutation cluster region. Our results indicate that different APC mutations provide cells with different selective advantages, with mutations close to codon 1,300 providing the greatest advantage. Allelic loss is selected strongly in cells with one mutation near codon 1,300. A different germline-somatic APC mutation association exists in FAP desmoids. APC is not, therefore, a classical tumor suppressor. Our findings also indicate a new mechanism for disease severity: if a broader spectrum of mutations is selected in tumors, the somatic mutation rate is effectively higher and more tumors grow.
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Affiliation(s)
- H Lamlum
- Molecular and Population Genetics Laboratory, Imperial Cancer Research Fund, 44, Lincoln's Inn Fields, London WC2A 3PX, UK
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230
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Kaufman A, Medow N, Phillips R, Zaidman G, Wagner RS. Treatment of epibulbar limbal dermoids. J Ophthalmic Nurs Technol 1999; 18:172-6. [PMID: 10847042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- A Kaufman
- Corneal and Refractive Surgery Service, University of Cincinnati, USA
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231
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Phillips R. New warning about cefaclor and serum sickness in children. Aust Fam Physician 1999; 28:539. [PMID: 10399381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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232
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Affiliation(s)
- A Kaufman
- Corneal and Refractive Surgery Service, University of Cincinnati, Ohio, USA
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233
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Jack M, Phillips R. Public-private partnership organizations in health care: cooperative strategies and models. Hosp Health Serv Adm 1999; 38:387-400. [PMID: 10128121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Value-adding partnerships have emerged as a preferred strategy of private health care providers to achieve high-quality, low-cost provider status. This same strategy can be applied by public sector providers through the creation of public-private partnership organizations (3POs). Strategies to build 3POs between local governments and their medical communities currently under development are outlined. The conceptual and practical aspects of implementing 3POs are presented.
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Affiliation(s)
- M Jack
- Robert Phillips Group, Lafayette, CA 94549
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234
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Abstract
OBJECTIVE To determine if birth weights greater than 4000 g can be predicted by ultrasound measurements of abdominal circumferences. METHODS In 1996, 254 newborns delivered at Tampa General Hospital weighed at least 4000 g, 84 of whom had ultrasound examinations within 2 weeks of delivery. Those were compared with 84 neonates with recent ultrasounds who weighed less than 4000 g. Data were abstracted retrospectively from maternal medical records. RESULTS The best linear predictor of birth weight was ultrasound measurement of abdominal circumference (AC), which had a correlation coefficient of 0.95. An AC measurement of 35 cm or more predicted 93% of macrosomic infants. Among 177 macrosomic infants born vaginally, 23 (13%) had shoulder dystocia. In that group, induction of labor was associated with a greater than three-fold increase in risk of shoulder dystocia (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.4, 8.2; P < .01). Labor augmentation was not associated with increased risk of shoulder dystocia. CONCLUSION Abdominal circumference measurements were useful in screening for suspected macrosomia. An AC measurement of 35 cm or more identified more than 90% of macrosomic infants who were at risk for shoulder dystocia. Induction of labor in macrosomic patients increased the risk of shoulder dystocia.
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Affiliation(s)
- A Jazayeri
- Department of Obstetrics and Gynecology, Louisiana State University Medical Center, Shreveport, USA
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235
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Viant WJ, Phillips R, Bielby MS, Zhu Y, Griffiths JG, Mohsen AM, Sherman KP. A technique for very high accuracy image intensifier calibration. Stud Health Technol Inform 1999; 62:379-80. [PMID: 10538391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Accurate characterisation of the image distortion within a fluoroscopic image intensifier is critical if it forms the vision component of an image guided surgical system. By considering non-linear dynamic distortion it is possible to greatly increase the accuracy of the image intensifier, although at the cost of some image quality.
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Affiliation(s)
- W J Viant
- Department of Computer Science, University of Hull, UK
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236
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Ylikorkala A, Avizienyte E, Tomlinson IP, Tiainen M, Roth S, Loukola A, Hemminki A, Johansson M, Sistonen P, Markie D, Neale K, Phillips R, Zauber P, Twama T, Sampson J, Järvinen H, Mäkelä TP, Aaltonen LA. Mutations and impaired function of LKB1 in familial and non-familial Peutz-Jeghers syndrome and a sporadic testicular cancer. Hum Mol Genet 1999; 8:45-51. [PMID: 9887330 DOI: 10.1093/hmg/8.1.45] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Germline mutations in LKB1 have been reported to underlie familial Peutz-Jeghers syndrome (PJS) with intestinal hamartomatous polyps and an elevated risk of various neoplasms. To investigate the prevalence of LKB1 germline mutations in PJS more generally, we studied samples from 33 unrelated PJS patients including eight non-familial sporadic patients, 20 familial patients and five patients with unknown family history. Nineteen germline mutations were identified, 12 (60%) in familial and four (50%) in sporadic cases. LKB1 mutations were not detected in 14 (42%) patients, indicating that the existence of additional minor PJS loci cannot be excluded. LKB1 is predicted to encode a serine/threonine kinase. To demonstrate the putative Lkb1 kinase function and to study the consequences of LKB1 mutations in PJS and sporadic tumors, we have analyzed the kinase activity of wild-type and mutant Lkb1 proteins. Interestingly, while most of the small deletions or missense mutations resulted in loss-of-function alleles, one missense mutation (G163D) previously identified in a sporadic testicular tumor demonstrated severely impaired but detectable kinase activity.
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Affiliation(s)
- A Ylikorkala
- Hartman Institute and Biocentrum Helsinki and Department of Medical Genetics, Haartman Institute, PO Box 21, University of Helsinki, 00014 Helsinki, Finland
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237
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Robb N, Phillips R, Cripps T. 'How do you find veins in people with very "fatty" arms or who seem to have very small (fragile) veins? Also, it is very hard to find cannulae narrower than 20G.'. SAAD Dig 1999; 16:19-20. [PMID: 11833102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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238
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Abstract
Hypertension is common in West Africa and likely to become more common as urbanisation increases. There are at present few facilities for the detection and management of hypertension so the influence it has on overall morbidity and mortality in the population is not clear. The objectives of the study were to assess: (a) renal disease and blood pressure related admissions and deaths among acute medical admissions to Komfo Anokye Teaching Hospital, Kumasi, during an 8-month period; and (b) the burden of renal disease among out-patient hypertensives at the same hospital. Ward admission books were examined in the four acute medical wards to ascertain admission diagnosis and cause of death (two 4-month periods in 1995 and 1996). Clinical assessment (blood pressure, plasma creatinine, proteinuria) was also made of 448 consecutive out-patient hypertensives seen between March 1995 and April 1996. Five hundred and ninety-three (17.9%) of 3317 acute medical admissions were ascribable to a cardiovascular cause (hypertension, heart failure, stroke); 171 (28.8%) of these died. One hundred and sixty-six (5.0%) had renal disease of whom 45 (27.1%) died, usually of end-stage renal disease. Among the 448 hypertensive out-patients, 30.2% (110 out of 365) had a plasma creatinine >140 micromol/l (48 > or = 400 micromol/l) and 25.5% (96 out of 376) had proteinuria. Eighty-nine of the 448 had a diastolic blood pressure > or =115 mm Hg; in this group 38 (42.7%) had a plasma creatinine of >140 micromol/l (and 18 or 20.2% > or =400 micromol/l). In conclusion, cardiovascular and renal disease are important contributors to morbidity and mortality among acute medical admissions to a large city hospital in Ghana. Among out-patient hypertensives renal disease is an important complication, especially in those with the more severe hypertension.
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Affiliation(s)
- J Plange-Rhule
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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239
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Houlston R, Bevan S, Williams A, Young J, Dunlop M, Rozen P, Eng C, Markie D, Woodford-Richens K, Rodriguez-Bigas MA, Leggett B, Neale K, Phillips R, Sheridan E, Hodgson S, Iwama T, Eccles D, Bodmer W, Tomlinson I. Mutations in DPC4 (SMAD4) cause juvenile polyposis syndrome, but only account for a minority of cases. Hum Mol Genet 1998; 7:1907-12. [PMID: 9811934 DOI: 10.1093/hmg/7.12.1907] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Juvenile polyps are present in a number of Mendelian disorders, sometimes in association only with gastrointestinal cancer [juvenile polyposis syndrome (JPS)] and sometimes as part of known syndromes (Cowden, Gorlin and Banayan-Zonana) in association with developmental abnormalities, dysmorphic features or extra-intestinal tumours. Recently, a gene for JPS was mapped to 18q21.1 and the candidate gene DPC4 (SMAD4) was shown to carry frameshift mutations in some JPS families. We have analysed eight JPS families for linkage to DPC4. Overall, there was no evidence for linkage to DPC4; linkage could be excluded in two of the eight pedigrees and was unlikely in two others. We then tested these eight families and a further 13 familial and sporadic JPS cases for germline mutations in DPC4. Just one germline DPC4 mutation was found (in a familial JPS patient from a pedigree unsuitable for linkage analysis). Like all three previously reported germline mutations, this variant occurred towards the C-terminus of the DPC4 protein. However, our patient's mutation is a missense change (R361C); somatic missense mutations in DPC4 have been reported previously in tumours. We therefore confirm DPC4 as a cause of JPS, but show that there is considerable remaining, uncharacterized genetic heterogeneity in this disease.
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Affiliation(s)
- R Houlston
- Cancer Genetics, Haddow Laboratories, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
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240
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Pinedo G, Phillips R. Labial fat pad grafts (modified Martius graft) in complex perianal fistulas. Ann R Coll Surg Engl 1998; 80:410-2. [PMID: 10209410 PMCID: PMC2503155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Complex perianal fistulas may at times be very difficult to treat. New vascularised tissue can reach the perineum from leg muscles and the omentum. A less well-known source is the labial fat tissue (modified Martius graft) which has a robust posterolateral pedicle and which can be useful as an adjunctive technique for high anterior anal and rectovaginal fistulas. Between November 1993 and July 1997, eight women (age range 18-55 years) underwent modified Martius grafting, six of the eight having a rectovaginal fistula and two a high complex (suprasphincteric) perianal fistula. Anorectal advancement flaps were performed in five patients and three had a transperineal approach with simultaneous anterior sphincter repair because of concurrent anal incontinence. All patients had a defunctioning stoma. The fistula healed in six of the eight patients (75%) and recurred in two patients. The stoma has been closed in five of the eight patients (one patient's fistula has healed but her stoma cannot be closed because of anal incontinence). This is a useful technique when confronted with a difficult anterior fistula in women.
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Affiliation(s)
- G Pinedo
- Department of Surgery, St Mark's Hospital, London
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241
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Abstract
This article combines data from a clinical trial of donepezil with costing figures to evaluate expected direct costs of care over 5 years after diagnosis of Alzheimer's disease (AD) for patients aged 75 years and over at diagnosis. A Markov model simulates the progression of elderly persons through changing levels of severity. The model compares three treatment regimes for each of two patient groups; mild AD at start of treatment; moderate AD at start of treatment. Patients are followed until 5 years after the start of the treatment. Despite the acquisition costs, use of donepezil is approximately cost-neutral for both 5 mg and 10 mg treatment groups and for patients initially at either mild or moderate states of illness. Expected costs are slightly higher than for the placebo group, but higher expenditure on drugs is partly offset by lower costs of care consequent on treated patients not declining as rapidly as those untreated. The model showed that donepezil patients spent less time in the state of severe dementia, where costs of care are higher. Sensitivity analysis on key assumptions demonstrated that expected costs were highly dependent on discount rate and, more significantly, on the mortality rate.
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Affiliation(s)
- A Stewart
- PSSRU, University of Kent at Canterbury, UK.
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242
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Matlib MA, Zhou Z, Knight S, Ahmed S, Choi KM, Krause-Bauer J, Phillips R, Altschuld R, Katsube Y, Sperelakis N, Bers DM. Oxygen-bridged dinuclear ruthenium amine complex specifically inhibits Ca2+ uptake into mitochondria in vitro and in situ in single cardiac myocytes. J Biol Chem 1998; 273:10223-31. [PMID: 9553073 DOI: 10.1074/jbc.273.17.10223] [Citation(s) in RCA: 259] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ruthenium red is a well known inhibitor of Ca2+ uptake into mitochondria in vitro. However, its utility as an inhibitor of Ca2+ uptake into mitochondria in vivo or in situ in intact cells is limited because of its inhibitory effects on sarcoplasmic reticulum Ca2+ release channel and other cellular processes. We have synthesized a ruthenium derivative and found it to be an oxygen-bridged dinuclear ruthenium amine complex. It has the same chemical structure as Ru360 reported previously (Emerson, J., Clarke, M. J., Ying, W-L., and Sanadi, D. R. (1993) J. Am. Chem. Soc. 115, 11799-11805). Ru360 has been shown to be a potent inhibitor of Ca2+-stimulated respiration of liver mitochondria in vitro. However, the specificity of Ru360 on Ca2+ uptake into mitochondria in vitro or in intact cells has not been determined. The present study reports in detail the potency, the effectiveness, and the mechanism of inhibition of mitochondrial Ca2+ uptake by Ru360 and its specificity in vitro in isolated mitochondria and in situ in isolated cardiac myocytes. Ru360 was more potent (IC50 = 0.184 nM) than ruthenium red (IC50 = 6.85 nM) in inhibiting Ca2+ uptake into mitochondria. 103Ru360 was found to bind to isolated mitochondria with high affinity (Kd = 0.34 nM, Bmax = 80 fmol/mg of mitochondrial protein). The IC50 of 103Ru360 for the inhibition of Ca2+ uptake into mitochondria was also 0.2 nM, indicating that saturation of a specific binding site is responsible for the inhibition of Ca2+ uptake. Ru360, as high as 10 microM, produced no effect on sarcoplasmic reticulum Ca2+ uptake or release, sarcolemmal Na+/Ca2+ exchange, actomyosin ATPase activity, L-type Ca2+ channel current, cytosolic Ca2+ transients, or cell shortening. 103Ru360 was taken up by isolated myocytes in a time-dependent biphasic manner. Ru360 (10 microM) applied outside intact voltage-clamped ventricular myocytes prevented Ca2+ uptake into mitochondria in situ where the cells were progressively loaded with Ca2+ via sarcolemmal Na+/Ca2+ exchange by depolarization to +110 mV. We conclude that Ru360 specifically blocks Ca2+ uptake into mitochondria and can be used in intact cells.
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Affiliation(s)
- M A Matlib
- Department of Pharmacology and Cell Biophysics, University of Cincinnati, Cincinnati, Ohio 45267-0575, USA.
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243
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Abstract
Here we report on the molecular characterization of the first molluscan NOS in the CNS of the pond snail Lymnaea stagnalis. This Lymnaea NOS (Lym-nNOS) which is expressed preferentially in the CNS is most similar to mammalian neuronal NOS but contains tandem repeats of a seven amino acid motif not found in any other known NOS. We have localized Lym-nNOS to the serotonergic cerebral giant cells (CGCs) which modulate synaptic transmission within a neural network that generates feeding behavior. Our results suggest that the CGCs employ both NO and serotonin in the modulation of the central neural network underlying feeding.
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Affiliation(s)
- S A Korneev
- Sussex Centre for Neuroscience, School of Biological Sciences, University of Sussex, Brighton, UK
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244
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Phillips R. A valuable resource instructors can use. Teaching TRIPP (Teaching Resource for Instructors in Prehospital Pediatrics). JEMS 1998; 23:64-6, 67. [PMID: 10177895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- R Phillips
- Center for Pediatric Emergency Medicine, Bellevue Hospital, New York City, USA
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246
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Phillips R, Donald A, Mousseau-Gershman Y, Powell T. Applying theory to practice--the use of 'ripple effect' plans in continuing education. Nurse Educ Today 1998; 18:12-19. [PMID: 9528525 DOI: 10.1016/s0260-6917(98)80029-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The difficulties students experience in applying theory to practice are well documented and educationalists have employed a variety of techniques in an effort to enhance effective application. This paper describes the utilization of one such teaching/learning strategy in a diploma level course in management for registered nurses and midwives. As problem-solving individual contracts of learning, 'ripple effect' plans enabled course participants to apply general principles of management theory to specific nursing management practice in their everyday world of nursing and midwifery work, making changes in practice and procedure which were visible and real.
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247
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Olschwang S, Markie D, Seal S, Neale K, Phillips R, Cottrell S, Ellis I, Hodgson S, Zauber P, Spigelman A, Iwama T, Loff S, McKeown C, Marchese C, Sampson J, Davies S, Talbot I, Wyke J, Thomas G, Bodmer W, Hemminki A, Avizienyte E, de la Chapelle A, Aaltonen L, Tomlinson I. Peutz-Jeghers disease: most, but not all, families are compatible with linkage to 19p13.3. J Med Genet 1998; 35:42-4. [PMID: 9475093 PMCID: PMC1051185 DOI: 10.1136/jmg.35.1.42] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A locus for Peutz-Jeghers syndrome (PJS) was recently mapped to chromosome 19p13.3. Each of 12 families studied was compatible with linkage to the marker D19S886. We have analysed 20 further families and found that the majority of these are consistent with a PJS gene on 19p13.3. Three families were, however, unlinked to 19p13.3 and none of the available PJS polyps from these families showed allele loss at D19S886. There were no obvious clinicopathological or ethnic differences between the 19p13.3 linked and unlinked families. There appears, therefore, to be a major PJS locus on chromosome 19p13.3 and the possibility exists of a minor locus (or loci) elsewhere.
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Hurst KS, Phillips R, Viant WJ, Mohsen AM, Sherman KP, Bielby M. Review of orthopaedic manipulator arms. Stud Health Technol Inform 1997; 50:202-8. [PMID: 10180541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Trajectory planning and implementation forms a substantial part of current and future orthopaedic practice. This type of surgery is governed by a basic orthopaedic principle [1] which involves the placement of a surgical tool at a specific site within a region, via a trajectory which is planned from X-ray based 2D images and governed by 3D anatomical constraints. The accuracy and safety of procedures utilising the basic orthopaedic principle depends on the surgeon's judgement, experience, ability to integrate images, utilisation of intra-operative X-ray, knowledge of anatomical-biomechanical constraints and eye hand dexterity. The surgeon must remain as the responsible medical expert in charge of the overall system. At the same time the surgeon covets the accuracy offered by Computer Assisted Surgery including a manipulator. A summary of current inadequacies of manipulators indicates that the main drivers for future work are that accuracy is critical in close contact with the environment, safety concerns dictate manipulator geometry and technological limitations are many. In any effort to develop an optimal manipulator to guide surgical instruments and tools it is an obvious first step to review and categorise current manipulators. The aim of this paper is to review all aspects of manipulator design against the five main criteria of ergonomics; safety; accuracy; sterility and measurable benefits such as reduced operative time, reduced surgical trauma and improved clinical results.
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Affiliation(s)
- K S Hurst
- Engineering Design & Manufacture Department, University of Hull, UK
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Marsh DJ, Roth S, Lunetta KL, Hemminki A, Dahia PL, Sistonen P, Zheng Z, Caron S, van Orsouw NJ, Bodmer WF, Cottrell SE, Dunlop MG, Eccles D, Hodgson SV, Järvinen H, Kellokumpu I, Markie D, Neale K, Phillips R, Rozen P, Syngal S, Vijg J, Tomlinson IP, Aaltonen LA, Eng C. Exclusion of PTEN and 10q22-24 as the susceptibility locus for juvenile polyposis syndrome. Cancer Res 1997; 57:5017-21. [PMID: 9371495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Juvenile polyposis syndrome (JPS; MIM 174900) is an autosomal dominant condition with incomplete penetrance characterized by hamartomatous polyps of the gastrointestinal tract and a risk of gastrointestinal cancer. Gastrointestinal hamartomatous polyps are also present in Cowden syndrome (CS; MIM 158350) and Bannayan-Zonana syndrome (BZS; also called Ruvalcaba-Myhre-Smith syndrome; MIM 153480). The susceptibility locus for both CS and BZS has recently been identified as the novel tumor suppressor gene PTEN, encoding a dual specificity phosphatase, located at 10q23.3. A putative JPS locus, JP1, which most likely functions as a tumor suppressor, had previously been mapped to 10q22-24 in both familial and sporadic juvenile polyps. Given the shared clinical features of gastrointestinal hamartomatous polyps among the three syndromes and the coincident mapping of JP1 to the region of PTEN, we sought to determine whether JPS was allelic to CS and BZS by mutation analysis of PTEN and linkage approaches. Microsatellite markers spanning the CS/BZS locus (D10S219, D10S551, D10S579, and D10S541) were used to compute multipoint lod scores in eight informative families with JPS. Lod scores of < -2.0 were generated for the entire region, thus excluding PTEN and any genes within the flanking 20-cM interval as candidate loci for familial JPS under our statistical models. In addition, analysis of PTEN using a combination of denaturing gradient gel electrophoresis and direct sequencing was unable to identify a germline mutation in 14 families with JPS and 11 sporadic cases. Therefore, at least a proportion of JPS cases are not caused by germline PTEN alteration or by an alternative locus at 10q22-24.
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Affiliation(s)
- D J Marsh
- Department of Adult Oncology and Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA
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