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Matthews E, Fialho D, Tan SV, Venance SL, Cannon SC, Sternberg D, Fontaine B, Amato AA, Barohn RJ, Griggs RC, Hanna MG. The non-dystrophic myotonias: molecular pathogenesis, diagnosis and treatment. ACTA ACUST UNITED AC 2009; 133:9-22. [PMID: 19917643 DOI: 10.1093/brain/awp294] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The non-dystrophic myotonias are an important group of skeletal muscle channelopathies electrophysiologically characterized by altered membrane excitability. Many distinct clinical phenotypes are now recognized and range in severity from severe neonatal myotonia with respiratory compromise through to milder late-onset myotonic muscle stiffness. Specific genetic mutations in the major skeletal muscle voltage gated chloride channel gene and in the voltage gated sodium channel gene are causative in most patients. Recent work has allowed more precise correlations between the genotype and the electrophysiological and clinical phenotype. The majority of patients with myotonia have either a primary or secondary loss of membrane chloride conductance predicted to result in reduction of the resting membrane potential. Causative mutations in the sodium channel gene result in an abnormal gain of sodium channel function that may show marked temperature dependence. Despite significant advances in the clinical, genetic and molecular pathophysiological understanding of these disorders, which we review here, there are important unresolved issues we address: (i) recent work suggests that specialized clinical neurophysiology can identify channel specific patterns and aid genetic diagnosis in many cases however, it is not yet clear if such techniques can be refined to predict the causative gene in all cases or even predict the precise genotype; (ii) although clinical experience indicates these patients can have significant progressive morbidity, the detailed natural history and determinants of morbidity have not been specifically studied in a prospective fashion; (iii) some patients develop myopathy, but its frequency, severity and possible response to treatment remains undetermined, furthermore, the pathophysiogical link between ion channel dysfunction and muscle degeneration is unknown; (iv) there is currently insufficient clinical trial evidence to recommend a standard treatment. Limited data suggest that sodium channel blocking agents have some efficacy. However, establishing the effectiveness of a therapy requires completion of multi-centre randomized controlled trials employing accurate outcome measures including reliable quantitation of myotonia. More specific pharmacological approaches are required and could include those which might preferentially reduce persistent muscle sodium currents or enhance the conductance of mutant chloride channels. Alternative strategies may be directed at preventing premature mutant channel degradation or correcting the mis-targeting of the mutant channels.
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Rajakulendran S, Tan SV, Matthews E, Tomlinson SE, Labrum R, Sud R, Kullmann DM, Schorge S, Hanna MG. A patient with episodic ataxia and paramyotonia congenita due to mutations in KCNA1 and SCN4A. Neurology 2009; 73:993-5. [PMID: 19770477 DOI: 10.1212/wnl.0b013e3181b87959] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Matthews E, Labrum R, Sweeney MG, Sud R, Haworth A, Chinnery PF, Meola G, Schorge S, Kullmann DM, Davis MB, Hanna MG. Voltage sensor charge loss accounts for most cases of hypokalemic periodic paralysis. Neurology 2008; 72:1544-7. [PMID: 19118277 DOI: 10.1212/01.wnl.0000342387.65477.46] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several missense mutations of CACNA1S and SCN4A genes occur in hypokalemic periodic paralysis. These mutations affect arginine residues in the S4 voltage sensors of the channel. Approximately 20% of cases remain genetically undefined. METHODS We undertook direct automated DNA sequencing of the S4 regions of CACNA1S and SCN4A in 83 cases of hypokalemic periodic paralysis. RESULTS We identified reported CACNA1S mutations in 64 cases. In the remaining 19 cases, mutations in SCN4A or other CACNA1S S4 segments were found in 10, including three novel changes and the first mutations in channel domains I (SCN4A) and III (CACNA1S). CONCLUSIONS All mutations affected arginine residues, consistent with the gating pore cation leak hypothesis of hypokalemic periodic paralysis. Arginine mutations in S4 segments underlie 90% of hypokalemic periodic paralysis cases.
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Matthews E, Guet A, Mayer M, Vicart S, Pemble S, Sternberg D, Fontaine B, Hanna MG. Neonatal hypotonia can be a sodium channelopathy: recognition of a new phenotype. Neurology 2008; 71:1740-2. [PMID: 19015492 DOI: 10.1212/01.wnl.0000335269.21550.0e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rajakulendran S, Farmer S, Yousry T, Ashton E, Abbs S, Holton J, Hanna M, Matthews E. G.P.12.03 Marked hemi-atrophy in a manifesting carrier of Duchenne muscular dystrophy—Possible role of skewed X-inactivation. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Matthews E, Guet A, Mayer M, Vicart S, Pemble S, Sternberg D, Fontaine B, Hanna M. D.P.2.13 Neonatal hypotonia can be a sodium channelopathy. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Suzuki R, Kontinen V, Matthews E, Williams E, Dickenson A. ENLARGEMENT OF THE RECEPTIVE FIELD SIZE TO LOW INTENSITY MECHANICAL STIMULATION IN THE RAT SPINAL NERVE LIGATION MODEL OF NEUROPATHY. J Peripher Nerv Syst 2008. [DOI: 10.1111/j.1529-8027.2000.22-48.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Matthews E, Clague H. A pilot study to explore the benefits of nutritional screening within the outpatient setting. Lung Cancer 2008. [DOI: 10.1016/s0169-5002(08)70049-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matthews E, Tan SV, Fialho D, Sweeney MG, Sud R, Haworth A, Stanley E, Cea G, Davis MB, Hanna MG. What causes paramyotonia in the United Kingdom? Common and new SCN4A mutations revealed. Neurology 2008; 70:50-3. [PMID: 18166706 DOI: 10.1212/01.wnl.0000287069.21162.94] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the clinical and genetic features in a large cohort of UK patients with sodium channel paramyotonia congenita. METHODS We conducted a UK-wide clinical and molecular genetic study of patients presenting with a phenotype suggestive of paramyotonia congenita. RESULTS We identified 42 affected individuals (28 kindreds). All cases met our core criteria for a clinical diagnosis of paramyotonia congenita. Seventy-five percent of patients (32 patients/20 kindreds) had SCN4A mutations. Twenty-nine subjects from 18 kindreds had exon 22 and 24 mutations, confirming these exons to be hot spots. Unexpectedly, 3 of these subjects harbored mutations previously described with potassium-aggravated myotonia (G1306A, G1306E). We identified two new mutations (R1448L and L1436P). Ten cases (8 kindreds) without mutations exhibited paramyotonia congenita with prominent pain and weakness. CONCLUSIONS This study identifies two new mutations, confirms SCN4A as a common cause of paramyotonia congenita in the UK, and suggests further allelic and possibly genetic heterogeneity.
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Prigent C, Papa F, Aires F, Rossow WB, Matthews E. Global inundation dynamics inferred from multiple satellite observations, 1993–2000. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2006jd007847] [Citation(s) in RCA: 344] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Tierney JB, Matthews E, Carrington SD, Mulcahy G. INTERACTION OF EIMERIA TENELLA WITH INTESTINAL MUCIN IN VITRO. J Parasitol 2007; 93:634-8. [PMID: 17626356 DOI: 10.1645/ge-1066r.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The mucus gel layer overlying the gastrointestinal epithelium plays an important role in host-pathogen interactions. The initial interaction between the coccidian parasite Eimeria tenella and host cells of the intestinal epithelium must occur across this mucus interface. In this study, we examined the relationship between E. tenella and avian mucin, in particular the effect of purified intestinal regional mucin on parasite adherence and invasion in vitro. Secreted mucin from the chicken duodenum and cecum was purified by density gradient centrifugation and gel chromatography. Parasite invasion studies were performed in the Madin-Darby bovine kidney cell model. Eimeria tenella adherence to chicken duodenal mucin was detected, whereas adherence to cecal or bovine mucin was not shown. Parasite invasion into epithelial cells was not influenced by bovine mucin, whereas chicken mucin purified from the duodenum and cecum significantly inhibited invasion. Inhibition of E. tenella invasion into cells by mucin from the duodenum was marginally greater than that of the cecum, but this was not significant. This study demonstrated E. tenella interaction with native chicken intestinal mucin, which in turn inhibited parasite invasion into epithelial cells in vitro.
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Irwin JA, Morrissey PEW, Ryan JP, Walshe A, O'Neill SM, Carrington SD, Matthews E, Fitzpatrick E, Mulcahy G, Corfield AP, Dalton JP. Glycosidase activity in the excretory-secretory products of the liver fluke, Fasciola hepatica. Parasitology 2004; 129:465-72. [PMID: 15521635 DOI: 10.1017/s0031182004005803] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fasciola hepatica secretes proteolytic enzymes and other molecules that are essential for host penetration and migration. This mixture may include enzymes required for the degradation of supramucosal gels, which defend epithelial surfaces against pathogen entry. These contain hydrated mucins that are heavily glycosylated. Excretory-secretory products (ES) from F. hepatica were examined for a range of glycosidase activities, using synthetic 4-methylumbelliferyl glycosides as substrates. The ES product contained at least 8 different glycosidase activities, the most abundant of which were beta-N-acetylhexosaminidase, beta-galactosidase and beta-glucosidase. Alpha-fucosidase, beta-glucuronidase, alpha-galactosidase, alpha-mannosidase and neuraminidase were also present. Beta-N-acetylhexosaminidase and beta-galactosidase were present in multiple isoforms (at least 4), whereas beta-glucosidase appeared to exist as one isoenzyme with a pI < 3.8. All three enzymes had acidic pH optima (4.5-5.0). Ovine small intestinal mucin was degraded by ES at pH 4.5 or 7.0, with or without active cathepsin L, the major protease found in F. hepatica ES. The ability of F. hepatica ES to degrade mucin in the presence or absence of active cathepsin L suggests that cathepsin L is not essential for mucin degradation. The abundance of beta-galactosidase and beta-hexosaminidase in ES supports a role for these enzymes in mucin degradation.
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Forrest K, Simpson SA, Wilson BJ, van Teijlingen ER, McKee L, Haites N, Matthews E. To tell or not to tell: barriers and facilitators in family communication about genetic risk. Clin Genet 2003; 64:317-26. [PMID: 12974737 DOI: 10.1034/j.1399-0004.2003.00142.x] [Citation(s) in RCA: 281] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Communication about genetic risk in families is an important issue for genetic counsellors. The objective of this study was to explore the barriers and facilitators in family communication about genetic risk. Semi-structured interviews were undertaken with patients in the Northeast of Scotland who had attended genetic counselling for risk of hereditary breast and ovarian cancer and Huntington's disease, and with some spouses/partners. The interviews confirmed that the issue of disclosure was a problem for some, and that there were generic communication issues common to both groups. Telling family members about genetic risk was generally seen as a family responsibility and family structures, dynamics and 'rules' influenced disclosure decisions. A sense of responsibility towards younger generations was also important. The level of certainty felt by a person in relation to his or her own risk estimate also influenced what he or she could tell other family members. Communication within a family about genetic risk is a complex issue and is influenced by both pre-existing familial and cultural factors and individuals' responses to risk information. If genetic counsellors understood how these factors operate in individual families they might be able to identify effective strategies to promote considered decisions and prevent unnecessary emotional distress.
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Matthews E. Enduring institutions: the Tuttle-Newton Home and the Gracewood State School and Hospital. RICHMOND COUNTY HISTORY 2001; 16:5-21. [PMID: 11635860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Barry E, Laffoy M, Matthews E, Carey D. Preventing accidental falls among older people in long stay units. IRISH MEDICAL JOURNAL 2001; 94:172, 174-6. [PMID: 11495234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A fall prevention programme for older long-stay patients in a 95 bedded District Hospital was undertaken. Data on falls and resulting injuries for the year prior to the intervention were compared with equivalent data after one year (Year 1) and after two years (Year 2) of the intervention. In the pre-intervention year 25% of patients had at least one fall compared with 20.9% and 17.4% in Year 1 and Year 2 respectively. This difference was not statistically significant. However, there were 21% fewer falls in Year 1 and 49.3% fewer in Year 2 than in the pre-intervention year. This difference was significant in Year 2. In both intervention years there was a significant reduction in the incidence of fracture from 20.5% of falls (pre-intervention) to 2.8% in Year 1 and no fractures occurred in Year 2. Significant reductions in soft tissue injuries occurred in Year 2 but not in Year 1, dropping from 38.5% (pre-intervention) to 36.1% and 15.4% respectively. The percentage of patients uninjured after a fall increased from 41% to 61.1% to 84.6%. This intervention reduced falls and their adverse consequences for older people living in the long stay unit. The effect of the intervention escalated in Year 2. The intervention cost IR4,800 pounds. Fall prevention should be part of the routine care of older people in all types of long stay care.
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Edwards A, Elwyn G, Covey J, Matthews E, Pill R. Presenting risk information--a review of the effects of "framing" and other manipulations on patient outcomes. JOURNAL OF HEALTH COMMUNICATION 2001; 6:61-82. [PMID: 11317424 DOI: 10.1080/10810730150501413] [Citation(s) in RCA: 250] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Discussing risks and benefits of treatments or care options is becoming an increasingly important part of modern health care. This paper reviews the literature about manipulations of risk and benefit information in the clinical setting. There is a paucity of evidence in this field, particularly when examining specific manipulations. Only three categories of manipulation had three or more studies. The available evidence shows that the way information is presented can have significant effects on decisions made. The largest effects are evident when relative risk information is presented, as compared with absolute risk data. In addition, "loss framing" is more effective in influencing screening uptake behaviors than "gain framing" (odds ratio 1.18 [95% confidence interval 1.01-1.38]). There is also a pattern of evidence from studies comparing simpler with more complex information, more data with less, and those comparing numerical with verbal descriptions of risks. These studies suggest that providing more information, and which is more understandable to the patient, is associated with improved patient knowledge and a greater wariness to take treatments or participate in trials. These findings can contribute to efforts to improve communication between professionals and patients.
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Suzuki R, Kontinen V, Matthews E, Williams E, Dickenson A. ENLARGEMENT OF THE RECEPTIVE FIELD SIZE TO LOW INTENSITY MECHANICAL STIMULATION IN THE RAT SPINAL NERVE LIGATION MODEL OF NEUROPATHY. J Peripher Nerv Syst 2000. [DOI: 10.1046/j.1529-8027.2000.00022-48.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Matthews E, Yang T, Janulis L, Goodwin S, Kundu SD, Karpus WJ, Lee C. Down-regulation of TGF-beta1 production restores immunogenicity in prostate cancer cells. Br J Cancer 2000; 83:519-25. [PMID: 10945501 PMCID: PMC2374659 DOI: 10.1054/bjoc.2000.1257] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The objective of this study is to determine if a non-immunogenic Dunning's rat prostate cancer cell line, MATLyLu, can become immunogenic by reducing the endogenous production of TGF-beta1. An expression construct containing a DNA sequence in an antisense orientation to TGF-beta1 (TGF-beta1 antisense) was stably transfected into MATLyLu cells. Following transfection, cellular content of TGF-beta1 reduced from 70 to 10 pg per 2x10(4) cells and the rate of in vitro 3H-thymidine incorporation increased 3-5-fold. After subcutaneous injection of tumour cells into syngeneic male hosts (Copenhagen rats), the tumour incidence was 100% (15/15) for the wild type MATLyLu cells and cells transfected with the control construct, but only 43% (9/21, P< or =0.05) for cells transfected with TGF-beta1 antisense. However, when cells were injected into immunodeficient hosts (athymic nude rats), the incidence of tumour development was 100% (10/10) for both the wild type MATLyLu cells and cells transfected with the control construct and 90% (9/10) for cells transfected with TGF-beta1 antisense. These observations support the concept that MATLyLu cells are immunogenic, when the endogenous production of TGF-beta1 is down-regulated.
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Edwards A, Hood K, Matthews E, Russell D, Russell I, Barker J, Bloor M, Burnard P, Covey J, Pill R, Wilkinson C, Stott N. The effectiveness of one-to-one risk communication interventions in health care: a systematic review. Med Decis Making 2000; 20:290-7. [PMID: 10929851 DOI: 10.1177/0272989x0002000305] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess whether risk-communication interventions are associated with changes in patient knowledge, attitudes, and behaviors, and to identify aspects of these interventions that modify these effects. DESIGN Systematic review. DATA SOURCES 96 studies from the period 1985-1996 retrieved by electronic searching of eight databases, hand searching of four journals, contacting key authors, and reference list searching. MAIN OUTCOME MEASURES The effect size of the principal outcome was identified from each study. Outcomes measuring behavioral change were preferred; if these were not available, knowledge, anxiety, or risk perceptions were used, according to the focus of the study. Data were available to calculate the principal effect sizes for 82 of the studies. ANALYSIS Meta-regression. RESULTS The methodologic qualities of the studies varied. Nevertheless, risk-communication interventions generally had positive (beneficial) effects. Interventions addressing treatment choices were associated with larger effects than were those in other contexts, such as prevention or screening. Interventions using individual risk estimates were associated with larger effects than were those using more general risk information. Two design variables were identified as effect modifiers: randomized controlled trials were associated with smaller effects than other designs, and dichotomous outcomes were associated with larger effects than continuous outcomes. CONCLUSIONS Risk communication interventions may be most productive if they include individual risk estimates in the discussion between professional and patient. Patient decisions about treatment appear more amenable to change by these interventions than attendance for screening or modification of risky behavior.
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Suzuki R, Kontinen VK, Matthews E, Williams E, Dickenson AH. Enlargement of the receptive field size to low intensity mechanical stimulation in the rat spinal nerve ligation model of neuropathy. Exp Neurol 2000; 163:408-13. [PMID: 10833315 DOI: 10.1006/exnr.2000.7371] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
One characteristic of plasticity after peripheral tissue or nerve damage is receptive field reorganization, and enlargement of receptive field size has been suggested to occur in certain models of neuropathic pain. The aim of the present study was to explore whether enlargement of neuronal receptive fields could contribute to the mechanical allodynia found on the ipsilateral paw in the spinal nerve ligation model of neuropathy. After ligation of L(5)-L(6) spinal nerves, all rats developed behavioral signs of mechanical allodynia, while the sham-operated control group displayed no such changes. The characteristics of the evoked responses of the neurones recorded in the dorsal horn of the rats were similar between the spinal nerve ligation, the sham operated control group, and the nonoperated control group, except for spontaneous activity, which was significantly increased in the spinal nerve ligation group. The mean size of the receptive field on the ipsilateral hindpaw, mapped using low-intensity stimulation with 9-g von Frey hair, was significantly increased in the spinal nerve ligation group, as compared to the sham-operated group. No significant difference was seen with 15- or 75-g von Frey hairs. The distribution of the receptive fields over the plantar surface of the paw was similar between the study groups. The enlargement of receptive field for non-noxious touch could be an indication of central sensitization in this model.
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Abstract
The aim of this paper is to consider possible justifications for the denial of the right to refuse treatment in the case of certain kinds of psychiatric patients. The basis of this right in general is first considered: arguments based on Kantian conceptions of autonomy are rejected as confused, and preference is given to Millian arguments based on the right to make decisions about one's own life, however irrational, as long as they do not harm others. In light of this discussion, it is argued that mentally disordered people cannot be denied this right on grounds of their 'irrationality', which is anyway a vague concept with several meanings. In conclusion, it is argued that there may be a case for such a denial in those sorts of mental disorder which involve a 'disturbance of personal identity'.
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Hansen JE, Sato M, Lacis A, Ruedy R, Tegen I, Matthews E. Climate forcings in the industrial era. Proc Natl Acad Sci U S A 1998; 95:12753-8. [PMID: 9788985 PMCID: PMC33912 DOI: 10.1073/pnas.95.22.12753] [Citation(s) in RCA: 272] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The forcings that drive long-term climate change are not known with an accuracy sufficient to define future climate change. Anthropogenic greenhouse gases (GHGs), which are well measured, cause a strong positive (warming) forcing. But other, poorly measured, anthropogenic forcings, especially changes of atmospheric aerosols, clouds, and land-use patterns, cause a negative forcing that tends to offset greenhouse warming. One consequence of this partial balance is that the natural forcing due to solar irradiance changes may play a larger role in long-term climate change than inferred from comparison with GHGs alone. Current trends in GHG climate forcings are smaller than in popular "business as usual" or 1% per year CO2 growth scenarios. The summary implication is a paradigm change for long-term climate projections: uncertainties in climate forcings have supplanted global climate sensitivity as the predominant issue.
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Edwards A, Matthews E, Pill R, Bloor M. Communication about risk: diversity among primary care professionals. Fam Pract 1998; 15:296-300. [PMID: 9792343 DOI: 10.1093/fampra/15.4.296] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We aimed to identify the important clinical topics and to report current practice of communication about risk in primary care. METHODS We carried out a qualitative study using six semi-structured focus group discussions with primary care professionals. The subjects were 36 primary care professionals from general practice, practice nurse, district nurse, community psychiatric nurse and health visitor disciplines. RESULTS All clinical topics were felt to raise issues of effective risk communication. Participants expressed concern about the lack of accessible up-to-date information and the problems of conveying information to patients. They described the circumstances and contexts in which communication varies and is difficult, and identified media and medico-legal influences and professional uncertainty as also contributing to the problems of risk communication. Specific training in risk communication was identified as an important need. CONCLUSIONS The complexity of risk communication and diversity of influences on it will require wide-ranging interventions in order to address them. Standardized communication may be a difficult goal to attain.
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Edwards A, Matthews E, Pill R, Bloor M. Communication about risk: the responses of primary care professionals to standardizing the 'language of risk' and communication tools. Fam Pract 1998; 15:301-7. [PMID: 9792344 DOI: 10.1093/fampra/15.4.301] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We aimed to gauge responses of primary care professionals to standardization of the 'language of risk' and risk communication tools. METHODS We carried out a qualitative study using six semi-structured focus group discussions. The subjects were 36 primary care professionals from general practice, practice nurse, district nurse, community psychiatric nurse and health visitor disciplines. RESULTS Between professionals, the standardization of the language of risk was felt to have potential benefit in making professionals consistent in their appreciation of risks and communication with each other. Between professionals and patients, standardized language was thought inappropriate or insufficient because of contextual variation in communication and interpretation of risk information by patients. The use of more-detailed comparisons of risks was felt to be a potentially effective development of risk communication in practice. CONCLUSIONS A standard language of risk communication was perceived as being potentially helpful for communication between professionals, but many respondents were sceptical about its usefulness in communication with patients.
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Shoji M, Hancock WW, Abe K, Micko C, Casper KA, Baine RM, Wilcox JN, Danave I, Dillehay DL, Matthews E, Contrino J, Morrissey JH, Gordon S, Edgington TS, Kudryk B, Kreutzer DL, Rickles FR. Activation of coagulation and angiogenesis in cancer: immunohistochemical localization in situ of clotting proteins and vascular endothelial growth factor in human cancer. THE AMERICAN JOURNAL OF PATHOLOGY 1998; 152:399-411. [PMID: 9466566 PMCID: PMC1857968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thrombin-catalyzed, cross-linked fibrin (XLF) formation is a characteristic histopathological finding in many human and experimental tumors and is thought to be of importance in the local host defense response. Although the pathogenesis of tumor-associated fibrin deposition is not entirely clear, several tumor procoagulants have been described as likely primary stimuli for the generation of thrombin (and XLF) in the tumor microenvironment (TME). In a previous study of a variety of human tumors we have shown that tissue factor (TF) is the major procoagulant. However, the relative contribution to fibrin deposition in the TME of tumor cell TF and host cell TF (eg, macrophage-derived) was not established. In addition, recent evidence has implicated TF in the regulation of the synthesis of the pro-angiogenic factor vascular endothelial growth factor (VEGF) by tumor cells. In the current study we used in situ techniques to determine the cellular localization of XLF, TF, VEGF, and an alternative tumor procoagulant, so-called cancer procoagulant (CP), a cysteine protease that activates clotting factor X. In lung cancer we have found XLF localized predominantly to the surface of tumor-associated macrophages, as well as to some endothelial cells and perivascular fibroblasts in the stromal area of the tumors co-distributed with TF at the interface of the tumor and host cells. Cancer pro-coagulant was localized to tumor cells in several cases but not in conjunction with the deposition of XLF. TF and VEGF were co-localized in both lung cancer and breast cancer cells by in situ hybridization and immunohistochemical staining. Furthermore, a strong relationship was found between the synthesis of TF and VEGF levels in human breast cancer cell lines (r2 = 0.84; P < 0.0001). Taken together, these data are consistent with a highly complex interaction between tumor cells, macrophages, and endothelial cells in the TME leading to fibrin formation and tumor angiogenesis.
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