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Cauldwell M, Mackie FL, Steer PJ, Henehghan MA, Baalman JH, Brennand J, Johnston T, Dockree S, Hedley C, Jarvis S, Khan S, McAuliffe FM, Mackillop L, Penna L, Smith B, Trivedi P, Verma S, Westbrook R, Winifield S, Williamson C. Pregnancy outcomes in women with primary biliary cholangitis and primary sclerosing cholangitis: a retrospective cohort study. BJOG 2020; 127:876-884. [DOI: 10.1111/1471-0528.16119] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
Affiliation(s)
- M Cauldwell
- Academic Department of Obstetrics and Gynaecology Chelsea and Westminster Hospital London UK
| | - FL Mackie
- Academic Department of Obstetrics and Gynaecology Birmingham Women’s and Children’s NHS Foundation Trust Birmingham UK
| | - PJ Steer
- Academic Department of Obstetrics and Gynaecology Chelsea and Westminster Hospital London UK
| | | | - JH Baalman
- UCD Perinatal Research Centre School of Medicine University College Dublin National Maternity Hospital Dublin Ireland
| | - J Brennand
- Department of Obstetrics Queen Elizabeth Hospital Glasgow Glasgow UK
| | - T Johnston
- Academic Department of Obstetrics and Gynaecology Birmingham Women’s and Children’s NHS Foundation Trust Birmingham UK
| | - S Dockree
- Women’s Centre Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - C Hedley
- Department of Obstetrics King’s College Hospital London UK
| | - S Jarvis
- Department of Obstetrics Queen Charlotte’s and Chelsea Hospital London UK
| | - S Khan
- Liver Unit Queen Elizabeth Hospital Birmingham UK
| | - FM McAuliffe
- UCD Perinatal Research Centre School of Medicine University College Dublin National Maternity Hospital Dublin Ireland
| | - L Mackillop
- Women’s Centre Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - L Penna
- Department of Obstetrics King’s College Hospital London UK
| | - B Smith
- Department of Hepatology Hammersmith Hospital London UK
| | - P Trivedi
- Liver Unit Queen Elizabeth Hospital Birmingham UK
| | - S Verma
- Department of Clinical and Experimental Medicine Brighton and Sussex Medical School Brighton UK
- Department of Gastroenterology and Hepatology Brighton and Sussex University Hospitals Brighton UK
| | - R Westbrook
- Department of Hepatology Royal Free Hospital London UK
| | - S Winifield
- Department of Obstetrics Leeds Teaching Hospitals Leeds UK
| | - C Williamson
- Department of Women and Children’s Health King’s College London London UK
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Keoghane S, Austin T, Coode-Bate J, Deverill S, Drake T, Sanpera-Iglesias J, Johnston T. The diagnostic yield of computed tomography in the management of acute flank pain and the emergency intervention rate for a proven acute ureteric stone. Ann R Coll Surg Engl 2018; 100:1-8. [PMID: 30286646 PMCID: PMC6204509 DOI: 10.1308/rcsann.2018.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The diagnostic and management pathways for patients presenting with acute flank pain are complex. Although computed tomography (CT) of the kidneys, ureters and bladder (KUB) is the gold standard investigation for urolithiasis, the multitude of differential diagnoses must also be considered in the context of long-term risk from ionising radiation. This study investigated the integrated role and diagnostic yield of non-contrast CT in cases of acute flank pain. METHODS A retrospective cohort study was undertaken of 1,442 consecutive patients investigated with CT KUB between March 2013 and February 2015. The primary outcome was diagnostic yield of CT with secondary outcomes being predictors of need for urological intervention. RESULTS A cause for acute flank pain was identified in 717 patients (50%), there was an incidental finding in 389 patients (27%) and normal imaging was reported in 336 patients (23%). A diagnosis was more commonly made in male than in female patients (70% vs 40%) and with increasing age (46% in patients aged <30 years, 56% in those aged 30-49 years and 63% in those aged ≥50 years). The overall rate for an ipsilateral urinary tract stone was 41%. Factors strongly associated with emergency intervention included stone size >10mm (odds ratio [OR]: 11.7, 95% confidence interval [CI]: 3.3-42.7), stones located at the pelviureteric junction (OR: 7.8, 95% CI: 2.6-22.9), C-reactive protein >50mg/l and ≤100mg/l (OR: 15.2, 95% CI: 5.1-45.3), and estimated glomerular filtration rate ≤30ml/min (OR: 5.8, 95% CI: 1.5-21.8). CONCLUSIONS This contemporary study identifies age and sex as independent variables affecting the diagnostic yield of CT KUB in cases of acute flank pain, and highlights factors associated with a need for emergency intervention in proven ureteric stones.
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Affiliation(s)
- S Keoghane
- West Suffolk NHS Foundation Trust, UK
- Portsmouth Hospitals NHS Trust, UK
| | - T Austin
- Portsmouth Hospitals NHS Trust, UK
| | | | | | - T Drake
- Portsmouth Hospitals NHS Trust, UK
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Keoghane SR, Deverill SJ, Woodhouse J, Shennoy V, Johnston T, Osborn P. Combined antegrade and retrograde access to difficult ureters: revisiting the rendezvous technique. Urolithiasis 2018; 47:383-390. [PMID: 29959479 DOI: 10.1007/s00240-018-1070-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/02/2018] [Accepted: 06/25/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Complex ureteric strictures present a significant challenge to the endourologist and uro-radiologist. Multiple separate interventions to try to cross the stricture are often attempted. We describe our experience managing a heterogenous patient group using the 'rendezvous' procedure. METHODS AND MATERIALS 16 patients and 18 ureters (one bilateral procedure, and two separate procedures in one patient) underwent rendezvous procedures. Seven patients had coexisting ureteric calculi treated. Each case was followed up for between 3 months and 5 years. RESULTS In 16/18 ureters there was technical success at time of surgery; successfully crossing the stricture, allowing ureteroscopic access to the ureter, dilating and/or stenting the ureter. 2/18 were unsuccessful; one secondary to advanced malignancy resulting in a uretero-vaginal fistula and the second a failure to remove a retained, displaced ureteric stent. Of the 18 ureteric procedures; 7/18 were stent free at 3 months, improving to 8/18 stent free at 6 months. 4/18 remained nephrostomy dependent (failure of drainage despite stent or failure to stent) at 3 months, increasing to 6/18 being nephrostomy dependent at 6 months. 1/16 remained dialysis dependent with a nephrostomy tube. For those procedures involving ureteric calculi, 6/7 were stone free and 1/5 had a persistent stone fragment requiring further intervention. CONCLUSIONS A combined approach may decrease the number of separate interventions required, with the aim of removing the need for a long-term nephrostomy, as well as providing opportunity to treat ureteric calculi in the context of stricture disease. Our experience has been that where the rendezvous has been required to treat strictures caused by malignant extrinsic compression, stenting has not been successful; this information is key to informed consent in a group of patients who may have a limited life expectancy.
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Affiliation(s)
- S R Keoghane
- Departments of Urology and Radiology, West Suffolk NHS Foundation Trust, Portsmouth and Bury St Edmunds, Suffolk, UK.
| | - S J Deverill
- Departments of Urology and Radiology, Portsmouth NHS Trust, Portsmouth, UK
| | - J Woodhouse
- Departments of Urology and Radiology, Portsmouth NHS Trust, Portsmouth, UK
| | - V Shennoy
- Departments of Urology and Radiology, West Suffolk NHS Foundation Trust, Portsmouth and Bury St Edmunds, Suffolk, UK
| | - T Johnston
- Departments of Urology and Radiology, West Suffolk NHS Foundation Trust, Portsmouth and Bury St Edmunds, Suffolk, UK
| | - P Osborn
- Departments of Urology and Radiology, Portsmouth NHS Trust, Portsmouth, UK
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Koprich J, Johnston T, Howson P, Reyes G, Omana V, Brotchie J. Characterization and reproducibility of a macaque model of Parkinson’s disease alpha-synucleinopathy. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hendriksz CJ, Anheim M, Bauer P, Bonnot O, Chakrapani A, Corvol JC, de Koning TJ, Degtyareva A, Dionisi-Vici C, Doss S, Duning T, Giunti P, Iodice R, Johnston T, Kelly D, Klünemann HH, Lorenzl S, Padovani A, Pocovi M, Synofzik M, Terblanche A, Then Bergh F, Topçu M, Tranchant C, Walterfang M, Velten C, Kolb SA. The hidden Niemann-Pick type C patient: clinical niches for a rare inherited metabolic disease. Curr Med Res Opin 2017; 33:877-890. [PMID: 28276873 DOI: 10.1080/03007995.2017.1294054] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Niemann-Pick disease type C (NP-C) is a rare, inherited neurodegenerative disease of impaired intracellular lipid trafficking. Clinical symptoms are highly heterogeneous, including neurological, visceral, or psychiatric manifestations. The incidence of NP-C is under-estimated due to under-recognition or misdiagnosis across a wide range of medical fields. New screening and diagnostic methods provide an opportunity to improve detection of unrecognized cases in clinical sub-populations associated with a higher risk of NP-C. Patients in these at-risk groups ("clinical niches") have symptoms that are potentially related to NP-C, but go unrecognized due to other, more prevalent clinical features, and lack of awareness regarding underlying metabolic causes. METHODS Twelve potential clinical niches identified by clinical experts were evaluated based on a comprehensive, non-systematic review of literature published to date. Relevant publications were identified by targeted literature searches of EMBASE and PubMed using key search terms specific to each niche. Articles published in English or other European languages up to 2016 were included. FINDINGS Several niches were found to be relevant based on available data: movement disorders (early-onset ataxia and dystonia), organic psychosis, early-onset cholestasis/(hepato)splenomegaly, cases with relevant antenatal findings or fetal abnormalities, and patients affected by family history, consanguinity, and endogamy. Potentially relevant niches requiring further supportive data included: early-onset cognitive decline, frontotemporal dementia, parkinsonism, and chronic inflammatory CNS disease. There was relatively weak evidence to suggest amyotrophic lateral sclerosis or progressive supranuclear gaze palsy as potential niches. CONCLUSIONS Several clinical niches have been identified that harbor patients at increased risk of NP-C.
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Affiliation(s)
- Christian J Hendriksz
- a Salford Royal NHS Foundation Trust , Manchester , UK
- b University of Pretoria , Pretoria , South Africa
| | - Mathieu Anheim
- c University of Strasbourg , Hautepierre Hospital , Strasbourg , France
| | - Peter Bauer
- d Institute of Medical Genetics and Applied Genomics, Tübingen University , Tübingen, Germany
- e CENTOGENE AG , Rostock , Germany
| | | | | | - Jean-Christophe Corvol
- h Sorbonne University , UPMC and Hôpital Pitié-Salpêtrière, Department of Nervous System Diseases , Paris , France
| | | | - Anna Degtyareva
- j Federal State Budget Institution, Research Center for Obstetrics , Gynecology and Perinatology , Moscow , Russia
| | | | - Sarah Doss
- l Charite University Medicine Berlin , Department of Neurology , Berlin , Germany
| | | | - Paola Giunti
- n University College London, Institute of Neurology , London , UK
| | - Rosa Iodice
- o University Federico II Naples , Naples , Italy
| | | | | | - Hans-Hermann Klünemann
- r University Clinic for Psychiatry and Psychotherapy, Regensburg University , Regensburg , Germany
| | - Stefan Lorenzl
- s Ludwig Maximillian University , Munich , Germany
- t Paracelus Medical University , Salzburg , Austria
| | - Alessandro Padovani
- u Neurology Unit, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | | | - Matthis Synofzik
- w Department of Neurodegenerative Diseases , Hertie Institute for Clinical Brain Research , Tübingen, Germany
- x German Center for Neurodegenerative Diseases (DZNE) , Tübingen, Germany
| | | | | | - Meral Topçu
- z Hacettepe University Children's Hospital , Ankara , Turkey
| | | | | | | | - Stefan A Kolb
- ac Actelion Pharmaceuticals Ltd , Allschwil , Switzerland
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Gnanapragasam VJ, Hori S, Johnston T, Smith D, Muir K, Alonzi R, Winkler M, Warren A, Staffurth J, Khoo V, Tree A, Macneill A, McMenemin R, Mason M, Cathcart P, de Souza N, Sooriakumaran P, Weston R, Wylie J, Hall E, Lane A, Cross W, Syndikus I, Koupparis A. Clinical management and research priorities for high-risk prostate cancer in the UK: Meeting report of a multidisciplinary panel in conjunction with the NCRI Prostate Cancer Clinical Studies Localised Subgroup. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415816651362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of high-risk prostate cancer has become increasingly sophisticated, with refinements in radical therapy and the inclusion of adjuvant local and systemic therapies. Despite this, high-risk prostate cancer continues to have significant treatment failure rates, with progression to metastasis, castrate resistance and ultimately disease-specific death. In an effort to discuss the challenges in this field, the UK National Clinical Research Institute’s Prostate Cancer Clinical Studies localised subgroup convened a multidisciplinary national meeting in the autumn of 2014. The remit of the meeting was to debate and reach a consensus on the key clinical and research challenges in high-risk prostate cancer and to identify themes that the UK would be best placed to pursue to help improve outcomes. This report presents the outcome of those discussions and the key recommendations for future research in this highly heterogeneous disease entity.
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Affiliation(s)
| | - S Hori
- Academic Urology Group, University of Cambridge, UK
| | - T Johnston
- Academic Urology Group, University of Cambridge, UK
| | - D Smith
- Prostate Cancer Support Association, UK
| | - K Muir
- Institute of Public Health, University of Manchester, UK
| | - R Alonzi
- Department of Clinical Oncology, Mount Vernon Cancer Centre, UK
| | - M Winkler
- Department of Urology, Charing Cross Hospital, UK
| | - A Warren
- Department of Pathology, Addenbrookes Hospital, UK
| | - J Staffurth
- Institute of Cancer and Genetics, Cardiff University, UK
| | - V Khoo
- Department of Clinical Oncology, Royal Marsden Hospital, UK
| | - A Tree
- Department of Clinical Oncology, Royal Marsden Hospital, UK
| | - A Macneill
- Department of Urology, Western General Hospital, NHS Lothian, UK
| | | | - M Mason
- Institute of Cancer and Genetics, Cardiff University, UK
| | - P Cathcart
- Department of Urology, UCL Hospitals, UK
| | | | | | - R Weston
- Department of Urology, Royal Liverpool University Hospital, UK
| | - J Wylie
- Department of Oncology, Christie Hospital, UK
| | - E Hall
- Clinical Trials and Statistics Unit; Institute of Cancer Research, UK
| | - A Lane
- Department of Social Medicine, University of Bristol, UK
| | - W Cross
- Department of Urology, St. James’s University Hospital, UK
| | - I Syndikus
- Radiotherapy Department, Clatterbridge Cancer Centre, UK
| | - A Koupparis
- Department of Urology, Bristol Urological Institute, UK
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Johnston T, Brown S, Kaliarntas K, Taylor C. NON-CONTACT INJURY INCIDENCE AND WARM UP OBSERVATION IN HOCKEY IN SCOTLAND. Br J Sports Med 2016. [DOI: 10.1136/bjsports-2016-096952.18] [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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Johnson BV, Mook L, Johnston T. Diagnosis and treatment of hereditary hemorrhagic telangiectasia in a pediatric patient with chronic cyanosis. Images Paediatr Cardiol 2016; 18:1-7. [PMID: 28405202 PMCID: PMC5270036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- BV Johnson
- Bryce Johnson: MS-3 University of Washington School of Medicine
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Dolan R, Linden D, Johnston T, Paterson G, Rossi J, Lynch N, Arbuckle S, MacLean A, Davey P. Learning safe practice by improving care: student-led intervention on oxygen prescribing in a respiratory ward. Scott Med J 2013; 58:204-8. [PMID: 24215037 DOI: 10.1177/0036933013508062] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The primary aim of this intervention was to improve oxygen prescribing in accordance with the 2008 British Thoracic Society guidelines for the prescription of emergency oxygen in adults. METHODS Eight final year medical students reviewed the drug charts of all patients admitted to the respiratory ward on a daily basis in order to collect data on five audit questions: (1) Has oxygen (O2) been prescribed? (2) Has an O2 target saturation level been indicated? (3) Has O2 been prescribed as an 'as required' (PRN) or 'continuous therapy'? (4) Has the prescription been signed? (5) Has O2 been signed for in every drug round since the original prescription? Following an initial audit cycle an educational poster was distributed to all clinical staff via email and hard copies of the poster were placed strategically throughout the ward before its effectiveness was measured. RESULTS During the pre-intervention phase, compliance with all five measures varied from 0 to 25%. There was an increase in the variation in compliance after the poster intervention to 14-44%; however, this masked better overall compliance with all five investigative questions with figures of 44%, 39% and 42% being recorded in three of the four post-intervention days. Overall there was increased compliance with four of the five audit questions. Indeed compliance with question 3 rose from 14% to 83%. CONCLUSIONS The poster intervention was marginally effective while also showing that students can improve prescribing in a clinical setting.
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Affiliation(s)
- R Dolan
- Specialty Registrar, University of Dundee Medical School, UK
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Kenyon S, Armstrong N, Johnston T, Walkinshaw S, Petrou S, Howman A, Cheed V, Markham C, McNicol S, Willars J, Waugh J. Standard- or high-dose oxytocin for nulliparous women with confirmed delay in labour: quantitative and qualitative results from a pilot randomised controlled trial. BJOG 2013; 120:1403-12. [PMID: 23786339 DOI: 10.1111/1471-0528.12331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evidence suggests that a high dose of oxytocin for nulliparous women at 37-42 weeks of gestation with confirmed delay in labour increases spontaneous vaginal birth. We undertook a pilot study to test the feasibility of this treatment. DESIGN Pilot double-blind randomised controlled trial. SETTING Three teaching hospitals in the UK. POPULATION A total of 94 consenting nulliparous women at term with confirmed delay in labour were recruited, and 18 were interviewed. METHODS Women were assigned to either a standard (2 mU/min, increasing every 30 minutes to 32 mU/minute) or a high-dose regimen (4 mU/minute, increasing every 30 minutes to 64 mU/minutes) oxytocin by computer-generated randomisation. Simple descriptive statistics were used, as the sample size was insufficient to evaluate clinical outcomes. The constant comparative method was used to analyse the interviews. MAIN OUTCOMES MEASURES The main outcome measures: number of women eligible; maternal and neonatal birth; safety; maternal psychological outcomes and experiences; health-related quality of life outcomes using validated tools and data on health service resource use; incidence of suspected delay of labour (cervical dilatation of <2 cm after 4 hours, once labour is established); and incidence of confirmed delay of labour (progress of <1 cm on repeat vaginal examination after a period of 2 hours). RESULTS We successfully developed systems to recruit eligible women in labour and to collect data. Rates of spontaneous vaginal birth (10/47 versus 12/47, RR 1.2, 95% CI 0.6-2.5) and caesarean section (15/47 versus 17/47, RR 1.1, 95% CI 0.6-2.0) were increased, and rates of instrumental birth were reduced (21/47 versus 17/47, RR 0.8, 95% CI 0.5-1.3). No evidence of increased harm for either mother or baby was found. The incidences of suspected delay (14%) and confirmed delay (11%) in labour were less than anticipated. Of those who did not go on to have delayed labour confirmed, all except one woman gave birth vaginally. CONCLUSIONS A pilot trial assessing the efficacy of high-dose oxytocin was feasible, but uncertainty remains, highlighting the need for a large definitive trial. The implementation of national guidance of suspected and confirmed delay in labour is likely to reduce intervention.
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Affiliation(s)
- S Kenyon
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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Westin S, Sun C, Broaddus R, Pal N, Nath V, Urbauer D, Schmeler K, Lu K, Bodurka D, Johnston T. Prospective phase II trial of the Levonorgestrel Intrauterine System (Mirena) to treat complex atypical hyperplasia and grade 1 endometrioid endometrial cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johnston L, Johnston T. J17 Huntington's disease—a training gap for mental health services? J Neurol Psychiatry 2010. [DOI: 10.1136/jnnp.2010.222661.17] [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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Khalil BA, Gillham JC, Foresythe L, Harding R, Johnston T, Wright C, Morabito A. Successful management of short gut due to vanishing gastroschisis - case report and review of the literature. Ann R Coll Surg Engl 2010; 92:W10-3. [PMID: 20529453 PMCID: PMC5696947 DOI: 10.1308/147870810x12659688852437] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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] [Accepted: 03/17/2010] [Indexed: 11/22/2022] Open
Abstract
Vanishing gastroschisis is a rare in utero complication of gastroschisis. It is associated with a high mortality. We present a case report of an infant with vanishing gastroschisis that was managed with a combination of reconstructive bowel surgery and hepatosparing parenteral nutrition. The technique is described and a review of the literature is provided.
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Affiliation(s)
- B A Khalil
- Department of Obstetrics, St Mary's Hospital for Women, Manchester, UK.
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Kim YS, Tedesco-Silva H, Johnston T, Lee P, Zibari G, Walker R, Mange K, Panis C, Wang Z, Cibrik D. LOWER INCIDENCE OF CYTOMEGALOVIRUS AND BK VIRUS WITH EVEROLIMUS VERSUS MYCOPHENOLATE IN DE NOVO RENAL TRANSPLANT PATIENTS: RESULTS FROM A MULTICENTER, PROSPECTIVE STUDY. Transplantation 2010. [DOI: 10.1097/00007890-201007272-00485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tedesco Silva H, Cibrik D, Johnston T, Lackova E, Mange K, Panis C, Walker R, Wang Z, Zibari G, Kim YS. Everolimus plus reduced-exposure CsA versus mycophenolic acid plus standard-exposure CsA in renal-transplant recipients. Am J Transplant 2010; 10:1401-13. [PMID: 20455882 DOI: 10.1111/j.1600-6143.2010.03129.x] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Everolimus allows calcineurin-inhibitor reduction without loss of efficacy and may improve renal-transplant outcomes. In a 24-month, open-label study, 833 de novo renal-transplant recipients were randomized to everolimus 1.5 or 3.0 mg/day (target troughs 3-8 and 6-12 ng/mL, respectively) with reduced-exposure CsA, or mycophenolic acid (MPA) 1.44 g/day plus standard-exposure CsA. Patients received basiliximab +/- corticosteroids. The primary endpoint was composite efficacy failure (treated biopsy-proven acute rejection, graft loss, death or loss to follow-up) and the main safety endpoint was renal function (estimated glomerular filtration rate [eGFR], by Modification of Diet in Renal Disease [MDRD]) at Month 12 (last-observation-carried-forward analyses). Month 12 efficacy failure rates were noninferior in the everolimus 1.5 mg (25.3%) and 3.0 mg (21.9%) versus MPA (24.2%) groups. Mean eGFR at Month 12 was noninferior in the everolimus groups versus the MPA group (54.6 and 51.3 vs 52.2 mL/min/1.73 m(2) in the everolimus 1.5 mg, 3.0 mg and MPA groups, respectively; 95% confidence intervals for everolimus 1.5 mg and 3.0 mg vs MPA: -1.7, 6.4 and -5.0, 3.2, respectively). The overall incidence of adverse events was comparable between groups. The use of everolimus with progressive reduction in CsA exposure, up to 60% at 1 year, resulted in similar efficacy and renal function compared with standard-exposure CsA plus MPA.
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Garza D, Sungar G, Johnston T, Rolston B, Ferguson J, Matheson G. 213: Thoracoabdominal Trauma in the National Football League: A Twenty-Eight Year Review. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.231] [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: 10/21/2022]
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Slomovitz BM, Lu KH, Johnston T, Munsell M, Ramondetta LM, Broaddus RR, Coleman RL, Walker C, Gershenson DM, Burke TW, Wolf J. A phase II study of oral mammalian target of rapamycin (mTOR) inhibitor, RAD001 (everolimus), in patients with recurrent endometrial carcinoma (EC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5502] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [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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Abstract
REASONS FOR PERFORMING STUDY Previous studies have suggested that temporomandibular joint (TMJ) kinematics depend on the type of food being masticated, but accurate measurements of TMJ motion in horses chewing different feeds have not been published. HYPOTHESIS The temporomandibular joint has a larger range of motion when horses chew hay compared to pellets. METHODS An optical motion capture system was used to track skin markers on the skull and mandible of 7 horses as they chewed hay and pellets. A virtual marker was created on the midline between the mandibles at the level of the 4th premolar teeth to represent the overall motion of the mandible relative to the skull during the chewing cycle. RESULTS Frequency of the chewing cycles was lower for hay than for pellets. Excursions of the virtual mandibular marker were significantly larger in all 3 directions when chewing hay compared to pellets. The mean velocity of the virtual mandibular marker during the chewing cycle was the same when chewing the 2 feeds. CONCLUSIONS The range of mediolateral displacement of the mandible was sufficient to give full occlusal contact of the upper and lower dental arcades when chewing hay but not when chewing pellets. POTENTIAL RELEVANCE These findings support the suggestion that horses receiving a diet high in concentrate feeds may require more frequent dental prophylactic examinations and treatments to avoid the development of dental irregularities associated with smaller mandibular excursions during chewing.
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Affiliation(s)
- S J Bonin
- McPhail Equine Performance Center, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan 48854, USA
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Slomovitz BM, Ramondetta LM, Johnston T, Lu KH, Broaddus RR, Muller P, Iyer RB, Burke TW, Gershenson DM, Wolf J. A phase I study of imatinib mesylate and paclitaxel in patients with advanced (stage IIIC/IV) or recurrent uterine papillary serous carcinoma (UPSC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.16025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16025 Background: Uterine serous carcinoma (USC) is a rare, aggressive uterine tumor biologically distinct from typical endometrial cancers. Imatinib mesylate (IM)-associated kinases (kit, abl, PDGFR-B) are overexpressed and activated in most tumors from patients (pts) with USC. Single agent paclitaxel (TAX) has a good response rate but short duration of response in pts with USC. The purpose of this study was to determine the maximum tolerated dose (MTD) and dose limiting toxicity (DLT) of escalated doses of IM with a fixed dose of TAX. Methods: Pts with newly diagnosed (stage IIIC/IV) or recurrent USC were eligible (pts were required to have tumors that expressed at least one of the IM-targeted kinases by immunohistochemistry). Measurable disease was not required. TAX was administered at 175 mg/m2 every three weeks. One dose reduction to 135 mg/m2 was allowed. IM was given daily (400 mg, 500 mg or 600 mg). A 3+3 design was implemented. Pts with measurable disease were treated until progression or treatment associated toxicity. Pts with no measurable disease were treated for six cycles. Results: 11 pts were enrolled. The median age was 62 years (47–79). A total of 50 cycles were administered. Three pts were treated at the first dose level (400 mg), 6 pts treated at the second dose level (500 mg), and 2 pts were treated at the highest dose level (600 mg). Three DLTs were observed (1 at 500 mg level and 2 at 600 mg level) including: rash, neutropenia, and fatigue. IM 500 mg daily and TAX 175 mg/m2 every three weeks was the MTD. There were 3 serious adverse events not related to treatment (infection, dyspnea, pain). Neutropenia was the most common grade 3 or 4 toxicity but only one patient required TAX dose reduction. 8 pts were evaluated for efficacy (2 with measurable disease, 6 with no measurable disease). 1 (of 2) pts with measurable disease had a partial response and was treated for 13 cycles. Of the 6 pts with no measurable disease, 2 recurred (5 and 10 months). The median disease free interval for the pts without recurrent disease was 22 months (6–30). Conclusion: Combination therapy of IM and TAX is well tolerated with minimal side effects in pts with advanced or recurrent USC. Initiation of the phase II component of this study is warranted to better evaluate efficacy. No significant financial relationships to disclose.
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Affiliation(s)
- B. M. Slomovitz
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - L. M. Ramondetta
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - T. Johnston
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - K. H. Lu
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - R. R. Broaddus
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - P. Muller
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - R. B. Iyer
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - T. W. Burke
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - D. M. Gershenson
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
| | - J. Wolf
- Weill Medical College of Cornell University, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX
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Landen CN, Coleman R, Milam MR, Johnston T, Iyer R, Gershenson DM, Ramirez P. A phase I trial of the proteosome inhibitor PS-341 in combination with carboplatin in platinum and taxane resistant ovarian cancer patinets. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5558 Background. PS-341 (Millenium Pharmaceuticals, Inc.), a proteosome inhibitor, affects p53, NFκB, cell adhesion molecules, and sensitivity to cytotoxic agents to promote apoptosis and inhibit metastasis in cancer cells. PS-341 alone rarely causes myelosupression or renal toxicity, and therefore is an attractive agent to use in combination with cytotoxic chemotherapy. This phase I study evaluates the safety, dose-limiting toxicities (DLTs), and optimal dose of PS-341 when combined with carboplatin in ovarian cancer patients with recurrent, platinum- and taxane-resistant disease. Methods: After IRB approval, patients with recurrent ovarian cancer, platinum and taxane resistant (progression on platinum and/or taxane therapy or recurrence within 6 months of completing platinum and/or taxane therapy), measurable disease, and performance status 0–2 were eligible and enrolled after giving informed consent. As guided by toxicity and pharmacokinetic data from single-agent phase I trials, PS-341 was administered on days 1, 4, 8, and 11 by IV push every 28 days with carboplatin (AUC 5) on day 1. Four dose levels were evaluated: 0.8, 1.0, 1.3, and 1.5 mg/m2. Dose was escalated if 0 of 3 or 1 of 6 patients had a DLT. The MTD was defined as 2 or more patients out of 6 with a DLT. Results: 21 women (median age 63, range 43–83), were treated with carboplatin and PS-341 at 0.8mg/ m2 (n=6), 1.0 mg/m2 (n=3), 1.3 mg/m2 (n=6), or 1.5 mg/m2. (n=6). At each level, respectively, there were 1, 0, 1, and 3 DLT’s attributable to PS- 341; all were grade 3, consisting of fatigue (n=3), nausea/vomiting/dehydration (n=1), and anorexia/dehydration/syncope (n=1). There were no Grade 4 toxicities. Common grade 2 toxicities included fatigue (n=12), nausea (n=10), anorexia, anemia, and dyspnea (n=7 each). 18 patients evaluable for response had stable disease (SD) or progression of disease (PD): at 0.8 mg/m2, SD=2, PD=3; at 1.0 mg/m2, PD=3; at 1.3 mg/m2, SD=3, PD=3; at 1.5 mg/m2, SD=3, PD=1. Median duration of stable disease was 4 months (range 3–10). Conclusions: The recommended dose of PS-341 in combination is 1.3 mg/m2. Treatment was well-tolerated with reversible side effects and no grade 4 toxicities, and at the optimal dose, there was a 50% rate of stable disease. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | - R. Iyer
- MD Anderson Cancer Ctr, Houston, TX
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Garza D, Besier T, Johnston T, Rolston B, Schorsch A, Matheson G, Annerstedt C, Lindh J, Rydmark M. Use of a virtual human performance laboratory to improve integration of mathematics and biology in sports science curricula in Sweden and the United States. Stud Health Technol Inform 2007; 125:140-2. [PMID: 17377252] [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: 05/14/2023]
Abstract
New fields such as bioengineering are exploring the role of the physical sciences in traditional biological approaches to problems, with exciting results in device innovation, medicine, and research biology. The integration of mathematics, biomechanics, and material sciences into the undergraduate biology curriculum will better prepare students for these opportunities and enhance cooperation among faculty and students at the university level. We propose the study of sports science as the basis for introduction of this interdisciplinary program. This novel integrated approach will require a virtual human performance laboratory dual-hosted in Sweden and the United States. We have designed a course model that involves cooperative learning between students at Göteborg University and Stanford University, utilizes new technologies, encourages development of original research and will rely on frequent self-assessment and reflective learning. We will compare outcomes between this course and a more traditional didactic format as well as assess the effectiveness of multiple web-hosted virtual environments. We anticipate the grant will result in a network of original faculty and student research in exercise science and pedagogy as well as provide the opportunity for implementation of the model in more advance training levels and K-12 programs.
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Affiliation(s)
- D Garza
- Stanford University, United States
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Shah S, Johnston T, Hoonbae J, Ranjan D. Effect of chronic glucocorticoid therapy and the gender difference on bone mineral density in liver transplant patients. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.323] [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: 11/27/2022]
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Ranjan D, Schmonsky K, Johnston T, Jeon H, Bouneva I, Erway E. Financial analysis of potential donor management at a medicare-approved transplant hospital. Am J Transplant 2006; 6:199-204. [PMID: 16433775 DOI: 10.1111/j.1600-6143.2005.01150.x] [Citation(s) in RCA: 14] [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: 01/25/2023]
Abstract
The purpose of this study was to perform a financial analysis of severe brain injured (SBI) patient management to determine potential reimbursement versus net losses in relation to organ donation and transplantation at a transplant center. We undertook a retrospective analysis of financial records of medically suitable referrals to the organ procurement organization (OPO) from our institution for fiscal years 2002-2003. This included (1) hospital cost and reimbursement, (2) OPO reimbursement for actual donors, (3) financial returns on local transplant activity solely supported by local donor activity and (4) Medicare incentives for local organ donation. There were 48 potential and 18 organ donors for this period. The consent rate reduced from 50% to 25% if family was offered withdrawal of care. After reimbursements from OPO, Medicare incentives and kidney transplant activity solely supported by local organ donation were figured in, the total returns were 244% of total cost of SBI patient management. Aggressive proactive management of severely brain injured patients remains a good medical practice. For Medicare-approved transplant centers, there are additional financial incentives to aggressively treat these patients and pursue organ donation. Prematurely offering withdrawal of care negatively impacts on the organ donation process and hurts institutions financially.
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Affiliation(s)
- D Ranjan
- Division of Transplant Surgery, University of Kentucky, Kentucky, USA.
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Vause S, Shiach C, Johnston T. Purpura fulminans in the early postnatal period in a woman with protein C deficiency. J OBSTET GYNAECOL 2004; 20:536-7. [PMID: 15512647 DOI: 10.1080/014436100434802] [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: 10/17/2022]
Affiliation(s)
- S Vause
- St Mary's Hospital and Manchester Royal Infirmary, UK
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Johnston T, Duty S. Changes in GABA(B) receptor mRNA expression in the rodent basal ganglia and thalamus following lesion of the nigrostriatal pathway. Neuroscience 2003; 120:1027-35. [PMID: 12927208 DOI: 10.1016/s0306-4522(03)00418-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [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: 11/28/2022]
Abstract
Loss of striatal dopaminergic innervation in Parkinson's disease (PD) is accompanied by widespread alterations in GABAergic activity within the basal ganglia and thalamus. Accompanying changes in GABA(B) receptor binding have been noted in some basal ganglia regions in parkinsonian primates, suggesting that plasticity of this receptor may also occur in PD. However, the molecular mechanisms underlying the changes in receptor binding and the manner and extent to which different GABA(B) receptor mRNA subunits and splice-variants are affected remain unknown. This study used in situ hybridisation to examine the full profile of changes in expression of the known rat GABA(B) receptor genes and gene variants in the basal ganglia and thalamus of rats, brought about by degeneration of the nigrostriatal tract. All of the GABA(B) mRNA species examined showed unique expression patterns throughout the basal ganglia and thalamus. In addition, all exhibited a marked loss of expression (between 46 and 80%) in the substantia nigra pars compacta of animals bearing a complete 6-hydroxydopamine-induced lesion of the nigrostriatal tract, confirming the presence of these variants in dopaminergic neurones in this region. Further analysis of autoradioagrams revealed additional changes only in GABA(B(1a)) mRNA in discrete anatomical regions. Expression of the GABA(B(1a)) variant was significantly increased in the substantia nigra pars reticulata (33+/-2%), entopeduncular nucleus (26+/-1%) and the subthalamic nucleus (16+/-1%). Since these regions all receive reduced GABAergic innervation following nigrostriatal tract lesioning, it is possible that the increased expression occurs as a compensatory measure. In conclusion, these data demonstrate that GABA(B) receptor genes exhibit regional- and subunit/variant-specific plasticity at the molecular level under parkinsonian conditions.
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Affiliation(s)
- T Johnston
- Neurodegenerative Disease Research Group, Wolfson Centre for Age-Related Diseases, Hodgkin Building, King's College London, Guy's Campus, SE1 1UL, London, UK
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Dye JF, Vause S, Johnston T, Clark P, Firth JA, D'Souza SW, Sibley CP, Glazier JD. Characterization of cationic amino acid transporters and expression of endothelial nitric oxide synthase in human placental microvascular endothelial cells. FASEB J 2003; 18:125-7. [PMID: 14597568 DOI: 10.1096/fj.02-0916fje] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [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: 11/11/2022]
Abstract
We investigated the expression and activity of arginine transporters and endothelial nitric oxide synthase (eNOS) in human placental microvascular endothelial cells (HPMEC). Using RT-PCR amplification products for eNOS, CAT1, CAT2A, CAT2B, CAT4, 4F2hc (CD98), rBAT and the light chains y+LAT1, y+LAT2, and b0+T1 were detected in HPMEC, but not B0+. Immunohistochemistry and Western blotting confirmed the presence of 4F2hc and CAT1 protein in HPMEC. 4F2hc-light chain dimers were indicated by a shift in molecular mass detected under nonreducing conditions. L-Arginine transport into HPMEC was independent of Na+ or Cl- and was inhibited by the neutral amino acid glutamine, but not by cystine. The Ki for glutamine inhibition was greater in the absence of Na+. Kinetic analysis supported a two-transporter model attributed to system y+L and system y+. Expression of eNOS in HPMEC was detectable by immunohistochemistry and ELISA but not by Western blotting. Activity of eNOS in HPMEC, measured over 48 h, either as the basal production of nitric oxide (NO) or as the accumulation of intracellular cGMP was not detectable. We conclude that HPMEC transport cationic amino acids by systems y+ and y+L and that basal eNOS expression and activity in these cells is low.
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Affiliation(s)
- J F Dye
- Leukocyte Biology, Division of Biomedical Sciences, Imperial College School of Medicine, London SW7 2AZ
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Johnston T, Reddy K, Mastrangelo M, Lucas B, Ranjan D. Multiple renal arteries do not pose an impediment to the routine use of laparoscopic donor nephrectomy. Clin Transplant 2002; 15 Suppl 6:62-5. [PMID: 11903390 DOI: 10.1034/j.1399-0012.2001.00012.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [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: 11/23/2022]
Abstract
UNLABELLED Since the first description by Ratner and collegues in 1996, laparoscopic live-donor nephrectomy is gaining wide acceptance in an attempt to minimize the donor morbidity, length of hospital stay and length of time to return to work. It is unknown whether multiple renal arteries pose additional problems with laparoscopic donor nephrectomy. In November 1998, our institution initiated laparoscopic donor nephrectomy program. In the ensuing 19 months, we performed 25 living donor renal transplants, 24 of them using laparoscopic donor nephrectomy. The left kidney was procured in all cases. Eight donor candidates (33%) had two or more renal arteries (two arteries in five patients and three patients). RESULTS In six cases (25%), findings at surgery differed from the CT angography results (in four cases, CT angiogram reported fewer arteries than were found at surgery and in two cases it reported more). We found no significant differences in both donor outcomes and recipient, based on the presence or absence of multiple renal arteries. Among donor outcomes, we found equivalent results for donor warm ischemia time total donor operating time, and donor length of stay. For recipient outcomes, we found no significant differences between groups for the incidence of acute tubular necrosis (ATN), graft survival and most recent serum creatinine. In one case, we constructed two arteries into a single conduit on the backtable prior to transplantation. However, in most cases with multiple arteries, we implanted the arteries separately into the recipient external iliac artery. Based on this experience, we do not find the presence of multiple renal arteries to be a barrier to the successful use of kidney grafts procured by laparoscopic donor nephrectomy.
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Affiliation(s)
- T Johnston
- Department of Surgery, University of Kentucky, Lexington, USA
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Abstract
Results of the noun-verb pair comprehension and production tests from the Test Battery for Auslan Morphology and Syntax (Schembri et al., 2000) are re-presented, re-analyzed, and compared to data from two other cases also dealing with noun-verb pairs: the Auslan lexical database and a comparison of Auslan and American Sign Language (ASL) signs. The data elicited through the test battery and presented in this article confirm the existence of formationally related noun-verb pairs in Auslan in which the verb displays a single movement and the noun displays a repeated movement. The data also suggest that the best exemplars of noun-verb pairs of this type in Auslan form a distinct set of iconic (mimetic) signs archetypically based on inherently reversible actions (such as opening and shutting). This strong iconic link perhaps explains why the derivational process appears to be of limited productivity, though it does appear to have "spread" to a number of signs that appear to have no such iconicity. There appears to be considerable variability in the use of the derivational markings, particularly in connected discourse, even for signs of the "open and shut" variety. Overall, the derivational process is apparently still closely linked to an iconic base, is incipient in the grammar of Auslan, and is thus best described as only partially grammaticalized.
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Affiliation(s)
- T Johnston
- Renwick College, Faculty of Education, University of Newcastle, Private Bag 29, Parramatta NSW 2124, Australia (e-mail:
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Affiliation(s)
- S Vause
- Fetomaternal Medicine, St Mary's Hospital, Hathersage Road, Manchester M13 0JH, UK.
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Spoltore T, Mulcahey MJ, Johnston T, Kelly K, Morales V, Rebuck C. Innovative programs for children and adolescents with spinal cord injury. Orthop Nurs 2000; 19:55-62; quiz 62-4. [PMID: 11153334 DOI: 10.1097/00006416-200019030-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A few innovative programs have enabled children with SCI to surpass traditional levels of independence defined solely on preservation of motor function. Implementation of unique upper extremity and bladder surgical programs has provided children with tetraplegia the ability to manipulate objects without equipment and to independently empty their bladder, respectively. Innovative surgical programs have also restored privacy, dignity, and spontaneity. These are important gains previously unachievable by young persons with tetraplegia. Functional electrical stimulation has advanced children's abilities in upright mobility and has made significant impact on their quality of life by restoring hand and bladder capacities. Nurses play a leadership role in the delivery and integration of these dynamic programs.
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Abstract
The assessment of climate change impacts on agriculture has emerged as a recognizable field of research over the past 15 years or so. In a relatively short period, this area of work has undergone a number of important conceptual and methodological developments. Among many questions that have been debated are the adaptability of agriculture to climate change and the importance of land management adjustments in reducing the adverse effects of climate change. In turn, this latter focus has spawned a discussion regarding the nature of adaptation and the ability of agriculture to respond to sudden and rapid climatic changes. In this paper we present an overview of this debate. It is argued that the first generation of climate change impact studies generally ignored the possibility that agriculturalists may adjust their farming practices in order to cope with climate change or to take advantage of new production opportunities. This conceptual oversight has been largely eliminated over the past five years or so. However, questions remain surrounding the likelihood that various adaptive strategies will actually be deployed in particular places. In this paper, we stress the importance of studying adaptation in the context of decision-making at the individual farm level and beyond.
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Affiliation(s)
- T Johnston
- Department of Geography, University of Lethbridge, Alberta, Canada.
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Strong DR, Greene RL, Hoppe C, Johnston T, Olesen N. Taxometric analysis of impression management and self-deception on the MMPI-2 in child-custody litigants. J Pers Assess 1999; 73:1-18. [PMID: 10497799 DOI: 10.1207/s15327752jpa730101] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The typology of impression management (IM), a deliberate attempt to create a positive social image, and self-deceptive positivity (SDP), an unintentional concealment of symptoms, were examined using taxometric procedures with MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) underreporting scales in several custody-litigant samples. IM was identified as a taxon using several procedures and estimates of the base rate that were consistent (.40, .37, .31, .36, .37). SDP was better characterized as a dimensional construct. Means and estimated validities for MMPI-2 underreporting scales in this sample are reported. IM and SDP appear to be distinct and measurable underreporting constructs on the MMPI-2.
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Johnston T, Talbot P. Recognition of depression and anxiety in primary care. General health questionnaire alone is not sufficient for making psychiatric diagnosis. BMJ 1999; 318:1558-9. [PMID: 10438209] [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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Johnston T. Modernising mental health services. Government has failed, not community care. BMJ 1999; 318:807. [PMID: 10215390] [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: 02/12/2023]
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Jansen M, Bournes P, Corvini P, Fang F, Finander M, Hmelar M, Johnston T, Jordan C, Nabiev R, Nightingale J, Widman M, Asonen H, Aarik J, Salokatve A, Nappi J, Rakennus K. High performance laser diode bars with aluminum-free active regions. Opt Express 1999; 4:3-11. [PMID: 19396250 DOI: 10.1364/oe.4.000003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present operating and lifetest data on 795 and 808 nm bars with aluminum-free active regions. Conductively cooled bars operate reliably at CW power outputs of 40 W, and have high efficiency, low beam divergence, and narrow spectra. Record CW powers of 115 W CW are demonstrated at 795 nm for 30% fill-factor bars mounted on microchannel coolers. We also review QCW performance and lifetime for higher fill-factor bars processed on identical epitaxial material.
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Abstract
OBJECTIVE To assess the ability of colour/pulsed Doppler ultrasound to detect failed physiologic change of the spiral arteries in pregnancies complicated by pre-eclampsia. DESIGN Prospective matched-pairs case controlled study. SETTING Tertiary referral teaching hospital. SAMPLE Sixteen women with severe pre-eclampsia and 16 normotensive controls. METHODS Colour/pulsed Doppler assessment of blood flow in the uterine arteries and spiral arteries in central and peripheral parts of the placental bed. MAIN OUTCOME MEASURES Impedance to blood flow in the spiral arteries in pre-eclamptic group compared with normotensive controls. RESULTS In women with pre-eclampsia there is significantly higher impedance to blood flow in spiral arteries compared with normotensive women. CONCLUSIONS Ultrasound colour/pulsed Doppler based investigation of blood flow in the spiral arteries in ongoing pregnancy can detect failed physiological change of these vessels in pre-eclampsia. This is in concordance with histologic data.
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Affiliation(s)
- R Matijevic
- University of Manchester Department of Obstetrics and Gynaecology, St. Mary's Hospital, Whitworth Park
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Johnston T. Do all Patients With Congestive Heart Failure Need Diagnostic Coronary Arteriography? J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)84214-3] [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: 10/16/2022]
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Rennie AC, Stewart G, Whiteford M, Johnston T, Tolmie JL. Expect the worse or hope for the best? Prenatal diagnosis of geleophysic dysplasia. Prenat Diagn 1997; 17:1067-70. [PMID: 9399356] [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
Geleophysic dysplasia is a rare, autosomal recessive disorder which causes disproportionate short stature associated with severe physical handicaps, but is compatible with survival into adulthood. We present a case, a first-born child, where genetic counselling difficulties arose following ultrasound recognition of short-limbed dwarfism in association with polyhydramnios and an initial incorrect prenatal diagnosis of lethal chondrodysplasia. After birth of the surviving affected infant, the parents had great difficulty accepting that there had been a prenatal misdiagnosis and they were greatly disappointed by our inability to predict the postnatal survival of an infant to whom no hope of life had previously been given. The correct diagnosis was not made until the proband was nearly 1 year old, and the true prognosis then became clearer. This experience underlines the relative ease of prenatal recognition of skeletal growth abnormalities compared with the considerable difficulties experienced in reaching a precise diagnosis. Thus, following prenatal diagnosis of unspecified chondrodysplasia when parents seek definite information about the prognosis, the temptation to be either overpessimistic or overoptimistic should be avoided.
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Affiliation(s)
- A C Rennie
- Royal Hospital for Sick Children, Yorkhill, Glasgow, U.K
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Reyneke JP, Johnston T, van der Linden WJ. Screw osteosynthesis compared with wire osteosynthesis in advancement genioplasty: a retrospective study of skeletal stability. Br J Oral Maxillofac Surg 1997; 35:352-6. [PMID: 9427445 DOI: 10.1016/s0266-4356(97)90409-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [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: 02/05/2023]
Abstract
OBJECTIVE To compare the skeletal stability of wire and screw fixation after advancement genioplasty. DESIGN Retrospective study. SETTING Teaching hospital and private practice, South Africa. SUBJECTS 40 Patients who required advancement genioplasty, 20 in each group. INTERVENTIONS Advancement genioplasty measurements made on cephalometric radiographs before and immediately after operation, and at least 6 months later. MAIN OUTCOME MEASURES Comparison of horizontal and vertical measurements. RESULTS In the screw (rigid) group mean horizontal advancement was 6.3 mm followed by a relapse of 0.3 mm during the follow up period. The corresponding figures for the wire (non-rigid) group were 5.8 and 0.5 mm. The two differed significantly in the degree of vertical change but the result is clinically unimportant. There was no difference in the degree of horizontal change. CONCLUSION There was no difference in skeletal stability between the two groups.
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Affiliation(s)
- J P Reyneke
- Division of Maxillofacial and Oral Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Vadhan-Raj S, Murray LJ, Bueso-Ramos C, Patel S, Reddy SP, Hoots WK, Johnston T, Papadopolous NE, Hittelman WN, Johnston DA, Yang TA, Paton VE, Cohen RL, Hellmann SD, Benjamin RS, Broxmeyer HE. Stimulation of megakaryocyte and platelet production by a single dose of recombinant human thrombopoietin in patients with cancer. Ann Intern Med 1997; 126:673-81. [PMID: 9139552 DOI: 10.7326/0003-4819-126-9-199705010-00001] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.6] [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: 02/08/2023] Open
Abstract
BACKGROUND Thrombocytopenia is frequently encountered in patients with cancer. It is associated with an increased risk for clinically important bleeding episodes, which increases the demand for platelet transfusion. OBJECTIVE To assess hematopoietic response to and clinical tolerance of recombinant human thrombopoietin, a recently cloned novel cytokine. DESIGN Phase I and II clinical cohort study. SETTING The University of Texas M.D. Anderson Cancer Center, Houston, Texas. PATIENTS 12 patients with sarcoma who had high risk for severe chemotherapy-induced thrombocytopenia. INTERVENTION A single intravenous dose of thrombopoietin (0.3 to 2.4 micrograms/kg of body weight) 3 weeks before chemotherapy. MEASUREMENTS Peripheral blood and bone marrow evaluation before and after thrombopoietin administration. RESULTS A single dose of thrombopoietin was associated with an increase in platelet counts (mean increase from baseline, 61% to 213%; P = 0.002) in a dose-related manner. This increase began by day 4 in most patients and peaked on a median of day 12. This sustained response was associated with a prolonged serum thrombopoietin half life (20 to 30 hours). The platelets appeared morphologically normal and showed normal aggregation in response to various agonists. Platelet response was accompanied by a dose-related increase in bone marrow megakaryocytes (as much as 4-fold); the expansion of the bone marrow progenitors of myeloid, erythroid, multipotential, and megakaryocytic lineages; and the marked mobilization of progenitors (maximum, 5.7-fold to 10-fold) of multiple cell lineages in the peripheral blood. Treatment was well tolerated, and no serious adverse events occurred. CONCLUSIONS Thrombopoietin, administered as a single dose, is a potent stimulus for prolonged platelet production in humans. It merits further evaluation for the prevention and treatment of thrombocytopenia.
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Affiliation(s)
- S Vadhan-Raj
- University of Texas M.D. Anderson Cancer Center, Houston, USA
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Johnston T, Messer LB. An in vitro study of the efficacy of mouthguard protection for dentoalveolar injuries in deciduous and mixed dentitions. Endod Dent Traumatol 1996; 12:277-85. [PMID: 9206375 DOI: 10.1111/j.1600-9657.1996.tb00527.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [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
Sports-related dental trauma remains a risk for children and adolescents. Although mouthguards provide protection, up to 25% of dentoalveolar injuries can occur with a mouthguard in place. This study examined the effect of mouthguard protection in an in vitro model. A total of 97 sheep mandibular segments with incisors at four developmental stages (early deciduous, ED, n = 37; middle deciduous, MD, n = 20; late deciduous, LD, n = 18; mixed dentition, PD, n = 22) was used. Customised pressure formed mouthguards (MG) provided protection from trauma produced by a servohydraulic materials testing machine to test incisors. Injuries were examined clinically, radiographically and by dissection. Mean forces required to produce dentoalveolar injury were significantly greater in test (with MG) teeth than control (no MG) teeth. Mean forces to produce injury in test teeth decreased with resorbing root lengths. Deciduous incisors differed in injury type: subluxations and horizontal root fractures predominated in test teeth; lateral luxations and horizontal root fractures in control teeth. Predominant injuries in test and control permanent incisors were enamel infractions and subluxations. The magnitude of lateral luxation measurements of individual teeth was reduced significantly by mouthguard protection in both deciduous and permanent dentitions. The mouthguard tended to increase the mobility of the teeth it encompassed and, in some instances, promoted dentoalveolar injury of adjacent teeth.
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Affiliation(s)
- T Johnston
- Paediatric Dentistry, School of Dental Science, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
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Xiao Q, Weiner H, Johnston T, Crabb DW. The aldehyde dehydrogenase ALDH2*2 allele exhibits dominance over ALDH2*1 in transduced HeLa cells. J Clin Invest 1995; 96:2180-6. [PMID: 7593603 PMCID: PMC185867 DOI: 10.1172/jci118272] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [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: 01/26/2023] Open
Abstract
Individuals heterozygous or homozygous for the variant aldehyde dehydrogenase (ALDH2) allele (ALDH2*2), which encodes a protein differing only at residue 487 from the normal protein, have decreased ALDH2 activity in liver extracts and experience cutaneous flushing when they drink alcohol. The mechanisms by which this allele exerts its dominant effect is unknown. To study this effect, the human ALDH2*1 cDNA was cloned and the ALDH2*2 allele was generated by site-directed mutagenesis. These cDNAs were transduced using retroviral vectors into HeLa and CV1 cells, which do not express ALDH2. The normal allele directed synthesis of immunoreactive ALDH2 protein (ALDH2E) with the expected isoelectric point. Extracts of these cells contained increased aldehyde dehydrogenase activity with low Km for the aldehyde substrate. The ALDH2*2 allele directed synthesis of mRNA and immunoreactive protein (ALDH2K), but the protein lacked enzymatic activity. When ALDH2*1-expressing cells were transduced with ALDH2*2 vectors, both mRNAs were expressed and immunoreactive proteins with isoelectric points ranging between those of ALDH2E and ALDH2K were present, indicating that the subunits formed heteromers. ALDH2 activity in these cells was reduced below that of the parental ALDH2*1-expressing cells. Thus, the ALDH2*2 allele is sufficient to cause ALDH2 deficiency in vitro.
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Affiliation(s)
- Q Xiao
- Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-5121, USA
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Abstract
Drooling occurs commonly in children with cerebral palsy (CP). Surgical procedures, known as slalodochoplasties, are often performed for the control of drooling. These include major salivary gland excision, parasympathetic nerve section, duct ligation, and duct re-routing. Alterations in saliva amount, flow, and consistency occur following sialodochoplasty, and the resultant effect on dental homeostasis requires further investigation. This controlled study investigated 19 children with CP following sialodochoplasty (surgery group) and 75 children with CP treated nonsurgically (control group) who attended our hospital. Dental caries experience-including dmft, DMFT, and partial DMFS scores of mandibular incisors and canines only-plaque index, and enamel developmental defects index were recorded. Saliva buffering capacity and bacterial counts were assessed. The surgical group (median DMFT = 5.00) had significantly more dental caries when compared with the control group (median DMFT = 0.00), Wilcoxon Signed-rank Test, P < 0.0001. This study has shown that children with CP following sialodochoplasty have increased risk of dental caries when compared with those treated nonsurgically for drooling. Although no caries predictors were identified, alterations to the caries-protective role of saliva are considered the likely cause. Children who undergo this procedure should receive intensive pre- and postsurgical preventive dental therapy.
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Affiliation(s)
- K B Hallett
- Department of Child Development and Rehabilitation, Royal Children's Hospital, Australia
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Abstract
In mice, parthenogenetic embryos die at the early postimplantation stage as a result of developmental requirements for paternally imprinted genes, particularly for formation of extraembryonic tissues. Chimaeric parthenogenetic<==>normal mice are viable, however, due to non-random differences in distribution of their two cell types. Species differences in imprinting patterns in embryo and extra-embryonic tissues mean that there are uncertainties in extrapolating these experimental studies to humans. Here, however, we demonstrate that parthenogenetic chimaerism can indeed result in viable human offspring, and suggest possible mechanisms of origin for this presumably rare event.
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Affiliation(s)
- L Strain
- University of Edinburgh, Department of Medicine, Western General Hospital, UK
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Abstract
Although the prevalence of dental caries in children has fallen in recent years, significant numbers of children are still treated for nursing caries. This form of rampant caries affects the primary dentition and causes rapid destruction of normally resistant surfaces. The treatment of nursing caries is multifactorial, involving the child, parents, dental team and other health care providers to ensure the restorative dental treatment is supported by parental education in caries prevention, oral hygiene and infant nutrition. This paper presents a literature review on the condition, followed by a case report of a child with nursing caries treated in the clinic under local anaesthesia.
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