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Van Vyve F, Mercier N, Papadopoulos J, Heijmans C, Dessy H, Monestier O, Dewulf JP, Roland D. A new case of sodium-dependent multivitamin transporter defect occurring as a life-threatening condition responsive to early vitamin supplementation and literature review. Mol Genet Genomic Med 2024; 12:e2388. [PMID: 38407570 PMCID: PMC10847706 DOI: 10.1002/mgg3.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Biallelic pathogenic variants in SLC5A6 resulting in sodium-dependent multivitamin transporter (SMVT) defect have recently been described as a vitamin-responsive inborn error of metabolism mimicking biotinidase deficiency. To our knowledge, only 16 patients have been reported so far with various clinical phenotypes such as neuropathy and other neurologic impairments, gastro-intestinal dysfunction and failure to thrive, osteopenia, immunodeficiency, metabolic acidosis, hypoglycemia, and recently severe cardiac symptoms. METHODS We describe a case report of a 5-month-old girl presenting two recurrent episodes of metabolic decompensation and massive cardiac failure in the course of an infectious disease. We compare clinical, biological, and genetic findings of this patient to previous literature collected from Pubmed database (keywords: Sodium-dependent multivitamin transporter (SMVT), SMVT defect/disorder/deficiency, SLC5A6 gene/mutation). RESULTS We highlight the life-threatening presentation of this disease, the stagnation of psychomotor development, the severe and persistent hypogammaglobulinemia, and additionally, the successful clinical response on early vitamin supplementation (biotin 15 mg a day and pantothenic acid 100 mg a day). Metabolic assessment showed a persistent increase of urinary 3-hydroxyisovaleric acid (3-HIA) as previously reported in this disease in literature. CONCLUSION SMVT deficiency is a vitamin-responsive inborn error of metabolism that can lead to a wide range of symptoms. Increased and isolated excretion of urinary 3-hydroxyisovaleric acid may suggest, in the absence of markedly reduced biotinidase activity, a SMVT deficiency. Prompt supplementation with high doses of biotin and pantothenic acid should be initiated while awaiting results of SLC5A6 sequencing as this condition may be life-threatening.
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Affiliation(s)
- F.‐X. Van Vyve
- Pediatric Intensive Care Unit, Department of PediatricsJolimont HospitalLa LouvièreBelgium
| | - N. Mercier
- Institut de Pathologie et de GénétiqueGosselies (Charleroi)Belgium
| | - J. Papadopoulos
- Pediatric Intensive Care Unit, Department of PediatricsJolimont HospitalLa LouvièreBelgium
| | - C. Heijmans
- Institut de Pathologie et de GénétiqueGosselies (Charleroi)Belgium
| | - H. Dessy
- Pediatric Intensive Care Unit, Department of PediatricsJolimont HospitalLa LouvièreBelgium
| | - O. Monestier
- Department of Molecular BiologyInstitute of Pathology and GeneticsCharleroiBelgium
| | - J. P. Dewulf
- Biochemical Genetics and Newborn Screening Laboratory, Department of Clinical ChemistryCliniques Universitaires Saint‐LucBrusselsBelgium
| | - D. Roland
- Department of Human Genetics, Center for Inherited Metabolic DisordersInstitute of Pathology and GeneticsCharleroiBelgium
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Spindler L, Etienney I, Abramowitz L, de Parades V, Pigot F, Siproudhis L, Adam J, Balzano V, Bouchard D, Bouta N, Bucau M, Carlo A, Chanal J, Charpentier C, Clifford G, Draullette M, Fathallah N, Ferré V, Fléjou JF, Fouéré S, Higuero T, Kassouri L, Kurt S, Laurain A, Leclerc E, Lepiller Q, Lesage AC, Mège D, Ménard A, Merle P, Mortreux P, Noël C, Péré H, Prétet JL, Roland D, Staumont G, Tracanelli L, Vuitton L, Wylomanski S, Zaegel-Faucher O. Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice. Tech Coloproctol 2024; 28:23. [PMID: 38198036 PMCID: PMC10781838 DOI: 10.1007/s10151-023-02899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.
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Affiliation(s)
- L Spindler
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - I Etienney
- Service de Proctologie, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - L Abramowitz
- Service de Proctologie, APHP Hôpital Bichat-Claude Bernard and Ramsay GDS Clinique Blomet, Paris, France
| | - V de Parades
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - F Pigot
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - L Siproudhis
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France
| | - J Adam
- Service d'Anatomopathologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Balzano
- Service de Gastroentérologie et Oncologie Digestive, CHU Tours, Tours, France
| | - D Bouchard
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - N Bouta
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - M Bucau
- Service d'Anatomopathologie, AP-HP Hôpital Bichat-Claude Bernard, Paris, France
| | - A Carlo
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France
| | - J Chanal
- Service de Dermatologie, AP-HP, Hôpital Tarnier, Paris, France
| | - C Charpentier
- Département de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, INSERM, IAME, Université de Paris, Paris, France
| | - G Clifford
- Early Detection, Prevention, and Infections Branch, International Agency for Research On Cancer, Lyon, France
| | - M Draullette
- Service d'Hépato-Gastroentérologie et Assistance Nutritive, AP-HP, Hôpital Beaujon, Clichy, France
| | - N Fathallah
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Ferré
- Département de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, INSERM, IAME, Université de Paris, Paris, France
| | - J-F Fléjou
- Service d'Anatomopathologie, Cerbapath, Paris, France
| | - S Fouéré
- Service de Dermatologie, AP-HP, Hôpital Saint-Louis, Université de Paris, Paris, France
- Centre des Maladies Sexuellement Transmises, AP-HP, Hôpital Saint-Louis, Paris, France
| | - T Higuero
- Gastro-entérologue, proctologue medico-chirurgical, Beausoleil, France
| | - L Kassouri
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - S Kurt
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Laurain
- Service de Proctologie, APHP Hôpital Bichat-Claude Bernard and Ramsay GDS Clinique Blomet, Paris, France
| | - E Leclerc
- Service d'Hépato-Gastroentérologie, CHU Clermont-Ferrand, Inserm, 3iHP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Q Lepiller
- Laboratoire de Virologie, CHU de Besançon, Besançon, France
| | - A-C Lesage
- Service de Proctologie, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - D Mège
- Service de Chirurgie Digestive, Université d'Aix Marseille, AP-HM, Hôpital de la Timone, Marseille, France
| | - A Ménard
- Institut Hospitalo-Universitaire Méditerranée Infection, AP-HM, Hôpital Nord, Université d'Aix Marseille, Marseille, France
| | - P Merle
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - P Mortreux
- Service de Gastroentérologie, Centre Hospitalier de Bethune Beuvry, Beuvry, France
| | - C Noël
- Service d'Hépato-Gastroentérologie, CHU de Brest, Brest, France
| | - H Péré
- Laboratoire de Virologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Functional Genomics of Solid Tumors (FunGeST), Centre de Recherche des Cordelier, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - J-L Prétet
- EA3181, Université de Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| | - D Roland
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - G Staumont
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - L Tracanelli
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - L Vuitton
- Service de Gastroentérologie, CHU de Besançon, Université de Bourgogne Franche-Comté, Besançon, France
| | - S Wylomanski
- Service de Gynécologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - O Zaegel-Faucher
- Service d'Immuno-Hématologie Clinique, AP-HM, CHU Sainte-Marguerite, Marseille, France
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Abstract
Introduction/Objective Amidst the SARS-CoV-2 pandemic, we have learned that other organs, aside from the lungs, are affected by the virus. Tissue damage has been documented both clinically and histologically in multiple systems including the gastrointestinal tract. Clinical symptoms of gastrointestinal distress may be correlated with histopathologic findings. Studies have shown direct infection of epithelial cells in the GI tract in patients with the disease. The objective of this study is to identify specific histologic alterations that are present in patients with COVID-19. Methods/Case Report At our institution, a retrospective analysis was conducted to evaluate all COVID-positive patients who underwent any gastrointestinal procedure within 30 days after their positive test. The time frame included January 1, 2020 to December 31, 2020. Chart reviews were performed to document radiographic studies, endoscopic findings, histopathologic analysis, and clinical symptoms. Results (if a Case Study enter NA) A total of 26 patients met our criteria for inclusion in the study. The cohort consisted of 10 males and 16 females ranging in age from 13 to 78 years. Tissue was sent for histologic analysis in 19 of these individuals. Tubular adenomas (13), chronic gastritis (11), and prominent intestinal lymphoid aggregates (7) were the most common pathologic findings (Table 1). Conclusion These findings suggest that the histopathologic findings rendered from GI procedures of patients with COVID-19 may be non-specific and may not reveal any morphologic correlate to the clinical signs and symptoms. We propose that histopathological abnormalities identified from GI samples of SARS-CoV-2 positive patients must be correlated with clinical symptoms, endoscopic findings, and imaging when available.
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Affiliation(s)
- C E Middleton
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
| | - N Varshney
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
| | - D Roland
- School of Medicine, University of Mississippi, Jackson, Mississippi, UNITED STATES
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Roland D, Rahmi G, Pérez-Cuadrado-Robles E, Perrod G, Jacques J, Barret M, Leblanc S, Berger A, Albouys J, Chaussade S, Cellier C. Endoscopic submucosal dissection in rectal tumors extending or not to the dentate line: A comparative analysis. Dig Liver Dis 2020; 52:296-300. [PMID: 31744774 DOI: 10.1016/j.dld.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The feasibility of endoscopic submucosal dissection (ESD) in rectal tumors extending to the dentate line (RTDL) is unclear. AIMS To analyze the outcomes of ESD in RTDL compared to non-RTDL, with a special focus on the lower rectum location. METHODS Observational multicenter retrospective study. All patients with a rectal tumor who underwent ESD in 2013-2017 were included. A comparative analysis between RTDL and non-RTDL groups was done. RESULTS Two-hundred and twenty-eight patients (median age: 69 years, range: 33-89, 51.3% male) with RTDL (n = 65, 28.5%) and non-RTDL lesions (n = 163, 71.5%) were included. There were no significant differences between the en-bloc (89.2% vs. 90.8%, p = 0.718), complete (60% vs. 71.8%, p = 0.084) and curative resection rates (58.5% vs. 68.7%, p = 0.141). The overall complication rate (4.6% vs. 8%, p = 0.370) was not different, independently of the rectal location. Local recurrence was higher in RTDL (7.3% vs. 1.5%, p = 0.065). The indication for surgery due to non-curative resections in the lower rectum was lower in RTDL (9.2% vs. 14.6%, p = 0.378). CONCLUSION The safety, effectiveness and long-term impact of ESD in RTDL and non-RTDLs is comparable. Local recurrence in the lower rectum may be higher in RTDL.
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Affiliation(s)
- Déborah Roland
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France.
| | | | - Guillaume Perrod
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Jérémie Jacques
- Department of Gastroenterology, Dupuytren University Hospital, Limoges, France
| | | | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Arthur Berger
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Jérémie Albouys
- Department of Gastroenterology, Dupuytren University Hospital, Limoges, France
| | | | - Christophe Cellier
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
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Abstract
Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the "answer is not one-size-fits-all". This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key 'think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.
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Affiliation(s)
- J S Minhas
- 1 Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK
| | - D Minhas
- 2 Department of Paediatrics, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - T Coats
- 3 Emergency Medicine Academic Group, Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW, UK
| | - J Banerjee
- 3 Emergency Medicine Academic Group, Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW, UK
| | - D Roland
- 4 Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester LE1 7RH, UK.,5 Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester LE1 5WW, UK
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Weinrich J, Roland D, Sauer M, Frank Oliver H, Meywald-Walter K, Adam G, Bannas P. Thorax-Röntgenuntersuchung von Flüchtlingen: eine Notwendigkeit? ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Weinrich
- Zentrum für Radiologie und Endoskopie des Universitätsklinikums Hamburg-Eppendorf, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - D Roland
- LungenClinic Großhansdorf, Pneumologie, Hamburg
| | - M Sauer
- Zentrum für Radiologie und Endoskopie des Universitätsklinikums Hamburg-Eppendorf, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - H Frank Oliver
- Zentrum für Radiologie und Endoskopie des Universitätsklinikums Hamburg-Eppendorf, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | | | - G Adam
- Zentrum für Radiologie und Endoskopie des Universitätsklinikums Hamburg-Eppendorf, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - P Bannas
- Zentrum für Radiologie und Endoskopie des Universitätsklinikums Hamburg-Eppendorf, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
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Roland D, Arshad F. DESCRIPTIVE STUDY OF PAEDIATRIC OBSERVATION PRIORITY SCORE (POPS) TRIAGE TOOL IN BRONCHIOLITIS. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.71] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sinton D, Hall J, Roland D. THE 'SQUEEZED SAMPLE': IS THERE A RELATIONSHIP BETWEEN FALSELY ELEVATED LACTATE AND POTASSIUM IN BLOOD GAS SAMPLES IN CHILDREN? Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.69] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roland D, Arshad F, Douglas A, Davies F. SPREADING INNOVATION IN CHILDREN'S EMERGENCY CARE: AN EXTERNAL PRAGMATIC VALIDATION OF THE PAEDIATRIC OBSERVATION PRIORITY SCORE. Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.8] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roland D, Alifieraki S, Anzar S, Davies F. WHAT IS THE RISK OF NEONATES PRESENTING TO EMERGENCY DEPARTMENTS WITH NO PHYSIOLOGICAL OR OBSERVATIONAL DERANGEMENT HAVING SEPSIS? Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.67] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Holden KA, Hussain SF, Roland D, Coats TJ, Gaillard EA. P92 Real-time online analysis of volatile organic compounds in the exhaled breath of preschool children. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.229] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Quality improvement (QI) is described as being about changing the way in which patient care is delivered. It is more than just a theoretical framework against which innovations can be introduced; it is about a rigorous patient-centric approach to the design and delivery of care. In this paper we will explore some of the practicalities of delivering quality improvement in paediatrics and child health, and explain why it is an approach that we all must take.
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Affiliation(s)
- R E Klaber
- Department of Paediatrics, Imperial College Healthcare NHS Trust, , London, UK
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Roland D, Oliver A, Edwards ED, Mason BW, Powell CVE. Use of paediatric early warning systems in Great Britain: has there been a change of practice in the last 7 years? Arch Dis Child 2014; 99:26-9. [PMID: 23995077 DOI: 10.1136/archdischild-2012-302783] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the use of paediatric early warning systems (PEWS) and rapid response teams (RRTs) in paediatric units in Great Britain. DESIGN Cross sectional survey. SETTING All hospitals with inpatient paediatric services in Great Britain. OUTCOME MEASURES Proportion of units using PEWS, origin of PEWS used, criterion included in PEWS, proportion of units with an RRT and membership of RRT. RESULTS The response rate was 95% (149/157). 85% of units were using PEWS and 18% had an RRT in place. Tertiary units were more likely than district general hospital to have implemented PEWS, 90% versus 83%, and an RRT, 52% versus 10%. A large number of PEWS were in use, the majority of which were unpublished and unvalidated systems. CONCLUSIONS Despite the inconclusive evidence of effectiveness, the use of PEWS has increased since 2005. The implementation has been inconsistent with large variation in the PEWS used, the activation criteria used, availability of an RRT and the membership of the RRT. There must be a coordinated national evaluation of the implementation, impact and effectiveness of a standardised PEWS programme in the various environments where acutely sick children are managed.
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Affiliation(s)
- D Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University of Leicester, , Leicester, Leics, UK
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16
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Abstract
Despite a general acknowledgment that research in children is necessary and ethical, the evidence base for child-specific treatments is still sparse. We investigated children's biomedical and health services research in the UK in relation to training, infrastructure and activity, research evidence, and visibility. We show that excellent opportunities for career researchers exist through a competitive, national integrated academic training programme, but that the number of academic paediatricians has decreased by 18% between 2000 and 2011, falling from 11·3% to 5·9% of the consultant workforce. The potential for rapid delivery of studies in children through the National Health Service (NHS) is not being realised: clinical trainees are poorly equipped with core research skills; most newly appointed consultant paediatricians have little or no research experience; less than 5% of contracted consultant time supports research; less than 2·5% of the 2 million children seen in the NHS every year are recruited to studies; and ten of the 20 UK children's hospitals do not have a clinical research facility. Support through National Institute for Health Research networks is good for studies into drugs, but inconsistent for non-drug research; less than 5% of registered studies involve children and only one children's biomedical research centre has been allocated funding from 2012. Of the UK annual public and charitable biomedical research expenditure of roughly £2·2 billion, about 5% is directed at child health research. The scant evidence base is impeding the development of clinical guidance and policy-less than 20% of the outputs of the National Institute for Health and Clinical Excellence are applicable to children. Paediatric representation on major research boards is weak. Parent and young people's advocacy is fragmented, and their views are insufficiently heeded by regulatory bodies. The strong UK Government commitment to biomedical research has not been translated fully to research for children. The power of research in children to turn the tide of the growing burden of non-communicable, chronic, adult diseases that have their origins in early life, to benefit the health of an ageing population and future generations, and to reduce health-care costs is inadequately recognised. On the basis of our findings, we make several recommendations to improve early-years research, including the formation of multidisciplinary, cross-institutional groups of clinical and non-clinical child health researchers and their access to diagnostic and laboratory facilities suitable for children; a unified Children's Research Network for drug studies and non-drug studies; regulatory assessment of research that is proportionate and based on consistent national criteria; an expansion of research posts; support for parents' and young people's advocacy; collaboration between children's research charities; improved research training for paediatric trainees; and closer integration of child health research with core NHS activities.
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Affiliation(s)
- Neena Modi
- Imperial College London, Chelsea and Westminster Hospital, London, UK.
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Roland D, Warren O, Klaber RE. Engaging with leadership learning in the workplace. Lancet 2012; 380:563. [PMID: 22883505 DOI: 10.1016/s0140-6736(12)61328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Fundamental reform to the way we train and develop our future workforce is planned. In order to successfully achieve change the engagement of those delivering care is necessary. In this study the authors used a novel participatory design to seek the opinions of medical students, foundation doctors, specialty trainees and consultants on some key statements regarding proposed improvements to postgraduate medical education. While there was overall agreement on many of the recommendations of the Temple report, some aspects were potentially divisive, with significant differences between the views of consultants and those more junior to them. This work emphasises the importance of engaging all members of the healthcare workforce, both present and future, in the reasons for, and outcomes of, healthcare reform.
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Affiliation(s)
- R E Klaber
- Department of Paediatrics, Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK.
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Roland D, Davies F, Lewis G. 028 Determining the effect of objective and subjective criteria on a risk assessment tool in a Children's Emergency Department. Emerg Med J 2011. [DOI: 10.1136/emermed-2011-200617.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Roland D, Geliot T, Patel A. 031 Delivering safety net advice and the Emergency Department Clinical Quality Indicator of unplanned re-attendance in children. Emerg Med J 2011. [DOI: 10.1136/emermed-2011-200617.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dupont V, Gierche M, Roland D, Joachim L, Vanhelleputte C. [X-linked adrenoleukodystrophy or the trap of making commonplace of child's psycho-cognitive disorders]. Rev Med Brux 2011; 32:46-51. [PMID: 21485464] [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: 05/30/2023]
Abstract
A 10-year-old boy is referred to the pediatric ward for regression of school performance and behavior problems. The clinic has been evolving for two years in a context of parental separation. Given the clinical deterioration, the patient is sent to child psychiatrist. A complete somatic checkup is achieved, he reveals white matter lesions suggesting the diagnosis of X-linked adrenoleukodystrophy (X-ALD) confirmed by the metabolic assay. No curative treatment will be offered given the stage of the disease; the patient dies within two years. The X-ALD is a degenerative disease of the white matter having a prevalence estimated at 1/20,000 cases worldwide. The mutated gene, located on the long arm of chromosome X, encodes a peroxisomal membrane protein. Over 500 mutations are known and cause a disorder of fatty acids beta-oxidation. Several phenotypes exist without phenotype-genotype relationship. The diagnosis of X-ALD is mainly based on brain magnetic resonance and blood very long chain fatty acids (VLCFA) blood level. Allogenic hematopoietic stem cell transplantation, only known cure can be achieved in patients with asymptomatic (from screening) or early stage. Without treatment, the survival prognosis at diagnosis is an average of 3 years. Genetic counseling and screenings (pre-natal, neo-natal and family) are essentials to improve this diagnosis. Vigilance is crucial when dealing with child's psycho-cognitive disorders.
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Affiliation(s)
- V Dupont
- Service de Pédiatrie, C.H.U. Tivoli, La Louvière.
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Wu G, Gunawardana P, Bryant M, Voitle R, Roland D. Effect of Molting Method and Dietary Energy on Postmolt Performance of Two Strains of Single Comb White Leghorn Hens. J APPL POULTRY RES 2008. [DOI: 10.3382/japr.2006-00053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Van Maldergem L, Moser AB, Vincent MF, Roland D, Reding R, Otte JB, Wanders RJ, Sokal E. Orthotopic liver transplantation from a living-related donor in an infant with a peroxisome biogenesis defect of the infantile Refsum disease type. J Inherit Metab Dis 2005; 28:593-600. [PMID: 15902563 DOI: 10.1007/s10545-005-0593-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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] [Received: 08/04/2004] [Accepted: 01/11/2005] [Indexed: 10/25/2022]
Abstract
Peroxisomal biogenesis defects include a number of severe neurodevelopmental disorders, among which infantile Refsum disease (IRD) occupies the mildest end of the spectrum. Although high docosahexaenoic acid (DHA) and low phytanic acid diets can correct some of the biochemical defects, they have not consistently altered the progressive course of the disease. We carried out orthotopic liver transplantation (OLT) in a mildly symptomatic 6-month-old infant who was a sibling of a severely neurologically impaired older sister. After transplantation the clinical course of this young child appeared much improved by comparison to her older sister. She walked alone at 4 years, had acceptable social interaction and had a noticeable recovery of audition. After transplantation her biochemical parameters were significantly improved: phytanic acid and very long-chain fatty acid (VLCFA) serum concentrations decreased. Abnormal bile acids disappeared from plasma. Although the OLT did not result in a cure of the disorder, the clinical and biochemical results suggest that OLT should be considered in mildly symptomatic patients.
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Affiliation(s)
- L Van Maldergem
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Loverval, Belgium.
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Liu Z, Bateman A, Bryant M, Abebe A, Roland D. Estimation of bioavailability of DL-methionine hydroxy analogue relative to DL-methionine in layers with exponential and slope-ratio models. Poult Sci 2004; 83:1580-6. [PMID: 15384910 DOI: 10.1093/ps/83.9.1580] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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
An experiment was conducted using molted hens to estimate the bioavailability of DL-methionine hydroxy analogue-free acid (MHA-FA) relative to DL-methionine (DLM). In this experiment, 5 supplemental levels (0.012, 0.024, 0.036, 0.048, and 0.060%) of DLM or equimolar concentrations of MHA-FA were added to a basal diet containing 14.97% protein and 0.27% methionine. The low protein diet was used to increase the sensitivity of laying hens to methionine deficiency. Feed consumption, egg production, egg mass, and egg weight increased (P < 0.05), and feed conversion decreased (P < 0.05) when DLM or MHA-FA was added to the basal diet for some supplemental methionine levels. There was no difference (P > 0.05) in feed consumption between hens fed DLM and hens fed MHA-FA. Regression analysis showed that the bioavailability of MHA-FA relative to DLM on a molar basis was 88.7% (egg production), 88.0% (egg mass), and 84.6% (egg weight) with the exponential model, and was 89.7% (egg production), 89.6% (egg mass), and 86.8% (egg weight) with the slope-ratio model. The average bioavailability of MHA-FA relative to DLM was 88% on a molar basis.
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Affiliation(s)
- Z Liu
- Department of Poultry Science, Auburn University, Auburn, Alabama 36849 USA
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Dehout F, Roland D, Treille de Granseigne S, Guillaume B, Van Maldergem L. Relief of gastrointestinal symptoms under enzyme replacement therapy [corrected] in patients with Fabry disease. J Inherit Metab Dis 2004; 27:499-505. [PMID: 15303007 DOI: 10.1023/b:boli.0000037342.59612.69] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [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: 11/12/2022]
Abstract
Gastrointestinal symptoms, including diarrhoea and abdominal pain, are one of the earliest and most frequently reported signs of Fabry disease, a rare X-linked lipid storage disorder. As the disease progresses, renal, cardiac and cerebrovascular complications develop, resulting in more serious symptoms and early mortality. The present study evaluated the effects of enzyme replacement therapy (ERT) with agalsidase alfa on the gastrointestinal symptoms of Fabry disease. Following 6 months of treatment, both the severity ( p < 0.02) and frequency ( p < 0.02) of abdominal pain decreased. For those patients who had received agalsidase alfa for more than 6 months, the observed improvement was generally maintained. This is the first study indicating a significant beneficial effect of ERT on gastrointestinal symptoms in a group of patients treated for Fabry disease.
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Affiliation(s)
- F Dehout
- Department of Nephrology, CHU, Intercommunale de Santé Publique du Pays de Charleroi, Charleroi, Belgium.
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Abstract
This article reports the findings of a study that attempted to elucidate whether pulsed magnetic energy stimulates neovascularization in vivo, using a microsurgically created arterial loop model in a prospective randomized trial of 108 rats (n = 12/group). Pulsed magnetic energies of 0.1 and 2.0 gauss were applied immediately postoperatively and for 4, 8, and 12 weeks, respectively, with a statistically significant increase in neovascularization among the treated animals compared with control rats. The study provides a starting point for future study and evaluation of the stimulation of angiogenesis with the use of pulsed magnetic energy and suggests a possible use of this modality to increase the quality of revascularized tissue.
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Affiliation(s)
- D Roland
- Department of Plastic and Reconstructive Surgery at the Albert Einstein College of Medicine, Bronx, NY, USA
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Raychaudhuri A, Chertock H, Chovan J, Jones LS, Kimble EF, Kowalski TJ, Peppard J, White DH, Satoh Y, Roland D. Inhibition of LTB4 biosynthesis in situ by CGS 23885, a potent 5-lipoxygenase inhibitor, correlates with its pleural fluid concentrations in an experimentally induced rat pleurisy model. Naunyn Schmiedebergs Arch Pharmacol 1997; 355:470-4. [PMID: 9109363 DOI: 10.1007/pl00004971] [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: 02/04/2023]
Abstract
An intrapleural injection of carrageenan in rats induced LTB4 and LTC4/D4/E4 biosynthesis, exudate formation, and cellular influx in the pleural cavity. An injection of calcium ionophore (A23187, 100 nmol) 16-18 h after carrageenan injection augmented leukotriene biosynthesis and exudate formation, but not cellular influx. The carrageenan-induced pleurisy model modifid by A23187 administration was used to study the oral effect of CGS 23885 (N-hydroxy-N-[(6-phenoxy-2H-1-benzopyran-3-yl)-methyl]urea), a potent 5-lipoxygenase (5-LO) inhibitor, on inflammatory parameters. CGS 23885 dose-dependently (1 to 30 mg/kg) inhibited the enhanced LTB4 and LTC4/D4/E4 (1 to 10 mg/kg) biosynthesis, but had no effect on enhanced exudate formation. An inhibitory effect of CGS 23885 of small magnitude on cellular influx due to carrageenan stimulation was seen at 30 mg/kg. The concentrations of CGS 23885 in the pleural fluid were dose-related, and a positive correlation (r2=0.989) between pleural fluid concentration of LTB4 and CGS 23885 was observed. The results confirm that CGS 23885 is a specific, orally active 5-LO inhibitor which can achieve concentrations in the pleural cavity sufficient to inhibit production of LTB4 and LTC4/D4/E4 in an ongoing inflammatory response.
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Affiliation(s)
- A Raychaudhuri
- Research Department, Novartis Pharmaceuticals Corporation, Summit, NJ 07901, USA
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Abstract
During a 63-month period, 28 consecutive patients suspicious for injury of the thoracic aorta were examined by computed tomography (CT). Twelve aortic ruptures were evidenced; pseudoaneurysm and mediastinal haematoma in close contact with the aorta were present in 12 patients, marginal lucency in 9, marginal irregularity in 8 and intimal flap in 6. CT was falsely negative in 1 patient with injury of the left subclavian artery. Angiography and surgery confirmed the diagnosis in 7 patients, and surgery alone in 5 patients. CT had a sensitivity of 92% and a specificity of 100%. The need for angiography was obviated in 67% of patients. A radiologist with experience in trauma management, CT and angiography should perform both examinations.
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Affiliation(s)
- J F Biquet
- Department of Medical Imaging, University Hospital Sart Tilman, Liege, Belgium
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Van Cauter EV, Polonsky KS, Blackman JD, Roland D, Sturis J, Byrne MM, Scheen AJ. Abnormal temporal patterns of glucose tolerance in obesity: relationship to sleep-related growth hormone secretion and circadian cortisol rhythmicity. J Clin Endocrinol Metab 1994; 79:1797-805. [PMID: 7989487 DOI: 10.1210/jcem.79.6.7989487] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To define the chronobiology of glucose tolerance and insulin secretion in obesity, nine obese men and nine lean men were studied during constant glucose infusion for 53 h, including 8 h of nocturnal sleep, 28 h of continuous wakefulness, and 8 h of daytime sleep. Blood samples were collected at 20-min intervals to assay glucose, insulin, C-peptide, cortisol, and GH. Sleep was polygraphically monitored. Abnormal temporal profiles of glucose regulation were observed during wakefulness and sleep in obese subjects. During daytime hours, the normal profile of glucose tolerance was reversed, as an improvement, rather than a deterioration, was observed from morning to late evening. This reversal of the daytime pattern appeared to be caused by a dual defect in glucose regulation during the previous night. Indeed, during early sleep, GH secretion was markedly reduced, and the nocturnal rises of glucose and insulin secretion were dampened. During late sleep, obese subjects failed to suppress insulin secretion and plasma glucose, resulting in high morning levels. Comparisons of metabolic and hormonal patterns during nocturnal and daytime sleep suggest that the failure to suppress insulin secretion in late sleep may reflect a relative insensitivity of the beta-cell to acute inhibitory effects of cortisol in addition to insulin resistance.
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Affiliation(s)
- E V Van Cauter
- Department of Medicine, University of Chicago, Illinois 60637
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Abstract
After a preliminary finding of ultrasonographically detectable ring structure within the yolk of avian eggs, a study was initiated to investigate these properties. Ultrasonographically detectable alternating hyperechoic and hypoechoic rings within the egg yolk were found to be consistent but variability occurred in ring numbers, thickness, and clarity. Rings were best seen at two days post oviposition and were not affected by refrigeration or heating of the yolks. The usefulness of rings in experimental studies of yolk content of lipoprotein is postulated.
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Affiliation(s)
- R E Cartee
- Department of Anatomy and Histology, College of Veterinary Medicine, Auburn University, Alabama 36849
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Van Cauter E, Blackman JD, Roland D, Spire JP, Refetoff S, Polonsky KS. Modulation of glucose regulation and insulin secretion by circadian rhythmicity and sleep. J Clin Invest 1991; 88:934-42. [PMID: 1885778 PMCID: PMC295490 DOI: 10.1172/jci115396] [Citation(s) in RCA: 299] [Impact Index Per Article: 9.1] [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: 12/29/2022] Open
Abstract
To define the roles of circadian rhythmicity (intrinsic effects of time of day independent of the sleep or wake condition) and sleep (intrinsic effects of the sleep condition, irrespective of the time of day) on the 24-h variation in glucose tolerance, eight normal men were studied during constant glucose infusion for a total of 53 h. The period of study included 8 h of nocturnal sleep, 28 h of continuous wakefulness, and 8 h of daytime sleep. Blood samples for the measurement of glucose, insulin, C-peptide, cortisol, and growth hormone were collected at 20-min intervals throughout the entire study. Insulin secretion rates were derived from C-peptide levels by deconvolution. Sleep was polygraphically monitored. During nocturnal sleep, levels of glucose and insulin secretion increased by 31 +/- 5% and 60 +/- 11%, respectively, and returned to baseline in the morning. During sleep deprivation, glucose levels and insulin secretion rose again to reach a maximum at a time corresponding to the beginning of the habitual sleep period. The magnitude of the rise above morning levels averaged 17 +/- 5% for glucose and 49 +/- 8% for calculated insulin secretion. Serum insulin levels did not parallel the circadian variation in insulin secretion, indicating the existence of an approximate 40% increase in insulin clearance during the night. Daytime sleep was associated with a 16 +/- 3% rise in glucose levels, a 55 +/- 7% rise in insulin secretion, and a 39 +/- 5% rise in serum insulin. The diurnal variation in insulin secretion was inversely related to the cortisol rhythm, with a significant correlation of the magnitudes of their morning to evening excursions. Sleep-associated rises in glucose correlated with the amount of concomitant growth hormone secreted. These studies demonstrate previously underappreciated effects of circadian rhythmicity and sleep on glucose levels, insulin secretion, and insulin clearance, and suggest that these effects could be partially mediated by cortisol and growth hormone.
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Affiliation(s)
- E Van Cauter
- Department of Medicine, University of Chicago, Illinois 60637
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Abstract
Chicken erythrocytes treated with 100-microM t-butyl hydroperoxide (t-BHP) were more than 80% hemolyzed in 2 h and more than 90% hemolyzed after 4 h of incubation. Autologous plasma retarded the rate of hemolysis of chicken red cells produced by t-BHP. Dialysis of chicken plasma resulted in a marked decrease in the ability of plasma to protect erythrocytes from hemolysis by t-BHP. Low molecular weight components of plasma such as uric acid are hypothesized to account for much of the dialyzable material that protects red cells from hemolysis.
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Affiliation(s)
- R C Smith
- Department of Animal and Dairy Sciences, Alabama Agricultural Experiment Station, Auburn Univerity 36849
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La Puma J, Silverstein MD, Stocking CB, Roland D, Siegler M. Life-sustaining treatment. A prospective study of patients with DNR orders in a teaching hospital. Arch Intern Med 1988; 148:2193-8. [PMID: 3178377 DOI: 10.1001/archinte.148.10.2193] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We conducted a prospective survey of attending, resident, and intern physicians who had written a "do not resuscitate" (DNR) order for 93 patients in their care. After writing a DNR order, 11% of respondents would still use chest compression if their patient experienced a cardiopulmonary arrest. Many physicians did not plan to withdraw therapy except intensive care, but most physicians planned to withhold a spectrum of life-sustaining therapies, from hemodialysis (86%) to intravenous fluids (21%). Attending and house-staff physicians generally agreed on whether to withdraw a given therapy or not but frequently disagreed on whether to withhold a therapy or not. After patient discharge or death, 88 charts were reviewed. None of the 88 patients was coded. Physicians initiated 68 life sustaining therapies in 43 patients and discontinued 64 therapies in 34 patients; there was no change in management in 31 patients. We conclude that individual physicians interpret the DNR order differently. These orders often are associated with the discontinuation or noninitiation of life-sustaining therapies other than emergency CPR.
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Affiliation(s)
- J La Puma
- Section of Clinical Ethics, Lutheran General Hospital, Park Ridge, IL 60068
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Druart F, Becot F, Roland D, Hidrot D, Descoins F, Martinez D. [Primary peritoneal carcinosis. A new case]. Presse Med 1985; 14:2305. [PMID: 2935828] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Mather A, Roland D. The automated thiosemicarbazide-diacetyl monoxime method for plasma urea. Clin Chem 1969; 15:393-6. [PMID: 5783794] [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: 01/16/2023]
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