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Reid A, de Klerk N, Ambrosini GL, Olsen N, Pang SC, Berry G, Musk AW. The effect of asbestosis on lung cancer risk beyond the dose related effect of asbestos alone. Occup Environ Med 2006; 62:885-9. [PMID: 16299098 PMCID: PMC1740938 DOI: 10.1136/oem.2005.020834] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine if the presence of asbestosis is a prerequisite for lung cancer in subjects with known exposure to blue asbestos (crocidolite). METHODS Former workers and residents of Wittenoom with known amounts of asbestos exposure (duration, intensity, and time since first exposure), current chest x ray and smoking information, participating in a cancer prevention programme (n = 1988) were studied. The first plain chest radiograph taken at the time of recruitment into the cancer prevention programme was examined for radiographic evidence of asbestosis according to the UICC (ILO) classification. Cox proportional hazards modelling was used to relate asbestosis, asbestos exposure, and lung cancer. RESULTS Between 1990 and 2002 there were 58 cases of lung cancer. Thirty six per cent of cases had radiographic evidence of asbestosis compared to 12% of study participants. Smoking status was the strongest predictor of lung cancer, with current smokers (OR = 26.5, 95% CI 3.5 to 198) having the greatest risk. Radiographic asbestosis (OR = 1.94, 95% CI 1.09 to 3.46) and asbestos exposure (OR = 1.21 per f/ml-year, 95% CI 1.02 to 1.42) were significantly associated with an increased risk of lung cancer. There was an increased risk of lung cancer with increasing exposure in those without asbestosis. CONCLUSION In this cohort of former workers and residents of Wittenoom, asbestosis is not a mandatory precursor for asbestos related lung cancer. These findings support the hypothesis that it is the asbestos fibres per se that cause lung cancer, which can develop with or without the presence of asbestosis.
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Reid A, de Klerk N, Ambrosini G, Olsen N, Pang SC, Musk AW. The additional risk of malignant mesothelioma in former workers and residents of Wittenoom with benign pleural disease or asbestosis. Occup Environ Med 2005; 62:665-9. [PMID: 16169910 PMCID: PMC1740875 DOI: 10.1136/oem.2004.018531] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To examine the hypothesis that people with benign pleural disease or asbestosis have an increased risk of malignant mesothelioma beyond that attributable to their degree of asbestos exposure. METHODS Former workers and residents of the crocidolite mining and milling town of Wittenoom are participating in a cancer prevention programme (n = 1988). The first plain chest radiograph taken at the time of recruitment into the cancer prevention programme was read for evidence of benign pleural disease and asbestosis, using the UICC classification. Crocidolite exposure of former workers was derived from employment records and records of dust measurements performed during the operation of the asbestos mine and mill between 1943 and 1966. Based on fibre counts, exposure for former residents was determined using duration of residence and period of residence (before and after a new mill was commissioned in 1957) and interpolation from periodic hygienic measures undertaken from personal monitors between 1966 and 1992. Cox proportional hazards modelling was used to relate benign pleural disease, asbestosis, asbestos exposure, and mesothelioma. RESULTS Between 1990 and 2002, there were 76 cases of mesothelioma (56 of the pleura and 20 of the peritoneum). Cases had more radiographic evidence of (all) benign pleural disease, pleural thickening, blunt/obliterated costophrenic angle, and asbestosis than non-cases. Adjusting for time since first exposure (log years), cumulative exposure (log f/ml-years), and age at the start of the programme, pleural thickening (OR = 3.1, 95% CI 1.2 to 7.6) and asbestosis (OR = 3.3, 95% CI 1.3 to 8.6) were associated with an increased risk of peritoneal mesothelioma. There was no increased risk for pleural mesothelioma. CONCLUSION The presence of benign pleural disease, in particular pleural thickening, and asbestosis appears to increase the risk of mesothelioma of the peritoneum, but not of the pleura beyond that attributable to indices of asbestos exposure in this cohort of subjects exposed to crocidolite.
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McKnight AJ, Shaw A, Goldsmith CE, Clarke L, Millar BC, McCaughan J, Elborn JS, Reid A, Moore JE. Comparison of in vitro susceptibilities to levofloxacin and ciprofloxacin with Pseudomonas aeruginosa and Stenotrophomonas maltophilia isolated from cystic fibrosis patients in Northern Ireland. Br J Biomed Sci 2005; 62:30-2. [PMID: 15816210 DOI: 10.1080/09674845.2005.11978067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yuan S, Armour R, Reid A, Abdel-Rahman KF, Rumsey DM, Phillips M, Nester T. Case report: massive postpartum transfusion of Jr(a+) red cells in the presence of anti-Jra. Immunohematology 2005; 21:97-101. [PMID: 16178666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Jr(a) is a high-prevalence antigen. The rare Jr(a-) individuals can form anti-Jr(a) after exposure to the Jr(a) antigen through transfusion or pregnancy. The clinical significance of anti-Jr(a) is not well established. This study reports a case of a 31-year-old woman with a previously identified anti-Jr(a) who required massive transfusion of RBCs after developing life-threatening postpartum disseminated intravascular coagulopathy. Despite the emergent transfusion of 15 units of Jr(a) untested RBCs, she did not develop laboratory or clinical evidence of acute hemolysis. The patient's anti-Jr(a) had a pretransfusion titer of 4 and a monocyte monolayer assay (MMA) reactivity of 68.5% (reactivity > 5% is considered capable of shortening the survival of incompatible RBCs). The titer increased fourfold to 64 and the MMA reactivity was 72.5% on Day 10 posttransfusion. Review of laboratory data showed evidence of a mild delayed hemolytic transfusion reaction by Day 10 posttransfusion. Despite rare reports of hemolytic transfusion reactions due to anti-Jr(a) in the literature, most cases, including this one, report that this antibody is clinically insignificant or causes only mild delayed hemolysis. Clinicians should be advised to balance the risks of withholding transfusion with the small chance of significant hemolysis after transfusion of Jr(a+) RBCs in the presence of anti-Jr(a).
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Abstract
Trauma of the ear is a common presentation to the emergency room, and consists of a variety of pathologies encompassing simple trauma to the auricle at one end of the spectrum and extending to temporal bone fractures complicated by facial nerve palsy and leak of cerebrospinal fluid. This paper looks at the application of fundamental principles in the assessment of such patients, and identifies manage ment strategies that can limit morbidity and improve outcomes. It is written as a simple guide for nonotolaryngologists, and emphasizes clinical assessment and disposal rather than actual treatment.
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156
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Avendaño M, Kunst AE, van Lenthe F, Bos V, Costa G, Valkonen T, Cardano M, Harding S, Borgan JK, Glickman M, Reid A, Mackenbach JP. Trends in socioeconomic disparities in stroke mortality in six european countries between 1981-1985 and 1991-1995. Am J Epidemiol 2005; 161:52-61. [PMID: 15615915 DOI: 10.1093/aje/kwi011] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This study assesses whether stroke mortality trends have been less favorable among lower than among higher socioeconomic groups. Longitudinal data on mortality by socioeconomic status were obtained for Finland, Norway, Denmark, Sweden, England/Wales, and Turin, Italy. Data covered the entire population or a representative sample. Stroke mortality rates were calculated for the period 1981-1995. Changes in stroke mortality rate ratios were analyzed using Poisson regression and compared with rate ratios in ischemic heat disease mortality. Trends in stroke mortality were generally as favorable among lower as among higher socioeconomic groups, such that socioeconomic disparities in stroke mortality persisted and remained of a similar magnitude in the 1990s as in the 1980s. In Norway, however, occupational disparities in stroke mortality significantly widened, and a nonsignificant increase was observed in some countries. In contrast, disparities in ischemic heart disease mortality widened throughout this period in most populations. Improvements in hypertension prevalence and treatment may have contributed to similar stroke mortality declines in all socioeconomic groups in most countries. Socioeconomic disparities in stroke mortality generally persisted and may have widened in some populations, which fact underlines the need to improve preventive and secondary care for stroke among the lower socioeconomic groups.
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157
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Reid A, Malone J. Q fever in Ireland. A seroprevalence study of exposure to Coxiella burnettii among Department of Agriculture workers. Occup Med (Lond) 2004; 54:544-7. [PMID: 15377752 DOI: 10.1093/occmed/kqh086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To estimate the risk of exposure to Coxiella burnettii among 'at risk' workers in Ireland. METHODS A cross-sectional seroprevalence study, using the complement fixation technique (CFT), was carried out among technical and support staff of the Department of Agriculture in Ireland (n = 375). Participants were divided into low- (n = 34), moderate- (n = 158) and high-risk (n = 83) groups according to the likelihood of occupational exposure. A result of <1:8 on CFT was accepted as normal, i.e. no evidence of past exposure to the causative organism, C. burnettii. Participants with titres of 1:16 were clinically assessed for evidence of past or present infection and interviewed regarding the possibility of non-occupational exposure. RESULTS The participation rate was 75% (n = 281). Overall, 24 of the 281 participants (8.5%, 95% confidence interval = 5.6-12.4%) tested positive (titres = 1:8). No statistically significant difference existed between the three groups (low, 8.8%; moderate, 9.5%; high, 7.2%). Of those reviewed (n = 10), no evidence of either past or present clinically significant illness was detected. Possible non-occupational exposure was identified in two cases. CONCLUSION Laboratory evidence of past exposure to Q fever is common amongst readily identifiable 'at risk' occupational groups in Ireland, and appropriate preventative steps are warranted. Employees who do not have direct exposure to animals or animal products, but who work in a high risk environment appear to have a similar risk of exposure C. burnettii. Although clinical illness appears to be rare, health care workers should consider the possibility of Q fever in cases of unexplained illness arising in those working in 'high risk' environments.
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Berry G, de Klerk NH, Reid A, Ambrosini GL, Fritschi L, Olsen NJ, Merler E, Musk AW. Malignant pleural and peritoneal mesotheliomas in former miners and millers of crocidolite at Wittenoom, Western Australia. Occup Environ Med 2004; 61:e14. [PMID: 15031405 PMCID: PMC1740749 DOI: 10.1136/oem.2003.008128] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To report the number of malignant pleural and peritoneal mesotheliomas that have occurred in former Wittenoom crocidolite workers to the end of 2000, and to compare this with earlier predictions. METHODS A group of 6493 men and 415 women who had worked at the former Wittenoom crocidolite mine and mill at some time between 1943 and 1966 have been followed up throughout Australia and Italy to the end of 2000. RESULTS The cumulative number of mesotheliomas up to 2000 was 235 in men (202 pleural, 33 peritoneal) and seven (all pleural) in women. There had been 231 deaths with mesothelioma (9% of known deaths). CONCLUSIONS The number of deaths in men with mesothelioma between 1987 and 2000 was at the low end of the predictions made earlier based on the number of cases to 1986. If this trend continues, it is predicted that about another 110 deaths with mesothelioma will occur in men by 2020.
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Lu G, Cannon PF, Reid A, Simmons CM. Diversity and molecular relationships of endophytic Colletotrichum isolates from the Iwokrama Forest Reserve, Guyana. ACTA ACUST UNITED AC 2004; 108:53-63. [PMID: 15035505 DOI: 10.1017/s0953756203008906] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The diversity and host specificity were studied of a collection of Colletotrichum strains derived from endophytic colonies in leaves of 12 tree species in the Iwokrama Forest Reserve, Guyana. Analysis included ISSR-PCR and RAPD molecular fingerprinting techniques, rDNA ITS sequencing and morphological and cultural characterization. Most strains belonged to one of two species, C. gloeosporioides and a further taxon which is probably referable to C. boninense. Almost no strains were found to be genetically identical, indicating that clonal reproduction does not play a prominent role. No degree of host specificity could be detected even at molecular fingerprint level. The implications for estimation of fungal diversity in closed tropical forests may be profound.
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Mrácek Z, Sturhan D, Reid A. Steinernema weiseri n. sp. (Rhabditida, Steinernematidae), a new entomopathogenic nematode from Europe. Syst Parasitol 2003; 56:37-47. [PMID: 12975620 DOI: 10.1023/a:1025531302519] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Steinernema weiseri n. sp. is described from a roadside with apple trees near Ceské Budejovice, Czech Republic. The species is also widely distributed in Germany and Slovakia, from where it had previously been reported as Steinernema spec. F. The British Steinernema sp. D1 is considered conspecific with S. weiseri n. sp. Males of the new species are mainly characterised by light brown, slightly curved spicules with a long manubrium and the presence of a short tail mucron in the second generation. Third-stage infective juveniles are characterised by a 'medium size' body and tail length, short hyaline tail portion (mostly around 1/3 of tail length), the excretory pore situated in the mid-pharynx region, lip region slightly offset, angular and flattened, and the lateral field having nine equally developed lines separated by eight distinct ridges. S. weiseri n. sp. is most similar to S. feltiae, with which it did not hybridise. RFLP analysis of the ITS region of the rDNA repeat shows S. weiseri n. sp. to be distinct from 50 other Steinernema species and isolates. The new species was found in a wide range of habitats and is readily maintained on Galleria mellonella larvae.
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161
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de Silva R, Lashley T, Gibb G, Hanger D, Hope A, Reid A, Bandopadhyay R, Utton M, Strand C, Jowett T, Khan N, Anderton B, Wood N, Holton J, Revesz T, Lees A. Pathological inclusion bodies in tauopathies contain distinct complements of tau with three or four microtubule-binding repeat domains as demonstrated by new specific monoclonal antibodies. Neuropathol Appl Neurobiol 2003; 29:288-302. [PMID: 12787326 DOI: 10.1046/j.1365-2990.2003.00463.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pathological inclusions containing fibrillar aggregates of hyperphosphorylated tau protein are a characteristic feature in the tauopathies, which include Alzheimer's disease, frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP-17), progressive supranuclear palsy, corticobasal degeneration and Pick's disease. Tau isoform composition and cellular and regional distribution as well as morphology of these inclusions vary in each disorder. Recently, several pathological missense and exon 10 splice-donor site mutations of the tau gene were identified in FTDP-17. Exon 10 codes for the second of four microtubule-binding repeat domains. The splice-site mutations result in increased inclusion of exon 10 which causes a relative increase in tau isoforms containing four microtubule-binding repeat domains over those containing three repeat domains. This could be a central aetiological mechanism in FTDP-17 and, perhaps, other related tauopathies. We have investigated changes in the ratio and distribution of three-repeat and four-repeat tau in the different tauopathies as a basis of the phenotypic range of these disorders and the selective vulnerability of different subsets of neurones. In this study, we have developed two monoclonal antibodies, RD3 and RD4 that effectively distinguish these closely related tau isoforms. These new isoform-specific antibodies are useful tools for analysing tau isoform expression and distribution as well as pathological changes in the human brain.
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162
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Reid A, Malone J. A cross-sectional study of employer and employee occupational health needs and priorities within the Irish Civil Service. Occup Med (Lond) 2003; 53:41-5. [PMID: 12576564 DOI: 10.1093/occmed/kqg005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to establish how important an occupational health unit (OHU) is to its clients, and to identify the perceived needs and priorities for such a service. METHODS A cross-sectional postal survey of a stratified, randomly selected group of employees (n = 760) and all human resources (HR) managers (n = 34) was conducted in the Irish Civil Service. Each participant was requested to rate the overall importance of the OHU and to prioritize eight proposed functions for the unit: medical surveillance, general health education, pre-employment/promotion medical assessments, ill-health retirement assessments, return-to-work (after sick leave) assessments, occupational health education, research, and general medical screening. The results were analysed according to age group, gender, grade and occupation. RESULTS There was a response rate of 69% from employees and 74% from personnel managers. Significantly more HR managers than employees (92 versus 81%) thought an occupational health service was either important or very important. There were also differences in prioritization of functions by employees and HR managers. HR managers prioritized those functions concerned with assessing individuals' fitness for work, notably pre-employment/promotional health assessments, whereas employees consider group-directed 'preventative' functions to be more important, i.e. general medical screening, health education and medical surveillance. Both sets of opinions are not mutually exclusive, and considerable overlap exists, notably in the areas of occupational and general health education.
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163
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Dixon RM, Smith DR, Reid A. Lithium salts as a marker of intake of supplements by cattle. ACTA ACUST UNITED AC 2003. [DOI: 10.1071/ea01155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In a series of experiments the appearance of lithium cation in plasma following ingestion or intravenous administration of lithium salts was measured in order to examine the suitability of lithium as a marker of supplement intake by cattle. In experiment 1, cattle were offered low quality hay ad libitum and 0.15, 0.4, 1.0 and 3.0 kg cottonseed meal (CSM) supplement per day. Following ingestion of lithium-labelled CSM, the lithium concentration in plasma reached a maximum after about 24 h and the subsequent decrease in concentration appeared to follow a single exponential relationship. The rate constant of this disappearance of lithium from plasma was greater (P<0.05) when 3.0 kg than when lesser amounts of lithium-labelled CSM were consumed. Plasma lithium concentrations 24 and 32 h after ingestion of lithium-labelled CSM were both linearly related to the amount of supplement consumed (r = 0.86 and 0.87, respectively, n = 32, P<0.001), indicating that the plasma lithium concentrations could be used to measure intakes of supplement by individual animals. In experiment 2, following intravenous administration of lithium chloride the disappearance of lithium from plasma over 96 h appeared to be best described by 3 exponential compartments. In experiment 3, cattle were offered molasses-based or loose mineral mix (LMM) supplement, or water, labelled with lithium and the rate constant of disappearance of lithium from plasma between 32 and 96 h was determined. The pattern of the decrease in plasma lithium concentration was similar to that observed in experiment 1. In experiment 4, the variation about the estimates of supplement intake was measured in heifers (n = 24) offered hay and water ad libitum and in addition a meal of 60 g of lithium-labelled molasses–urea supplement; between 20 and 28 h after ingestion of the lithium-labelled supplement the coefficient of variation (CV) among animals in plasma lithium concentration was about 15%. The likely errors associated with the use of lithium salts to measure intake of supplement are discussed. These experiments confirm that lithium salts can be used as a marker to estimate intake of supplement by individual animals.
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Hunt D, Manzanilla-López R, Reid A. Nacobbus aberrans (Thorne, 1935) Thorne & Allen, 1944 (Nematoda: Pratylenchidae); a nascent species complex revealed by RFLP analysis and sequencing of the ITS-rDNA region. NEMATOLOGY 2003. [DOI: 10.1163/156854103769224421] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AbstractTwelve populations of Nacobbus aberrans, sensu lato, from Mexico, Bolivia, Peru, Ecuador and Argentina were subjected to molecular analysis of their genetic variability. RFLP banding patterns revealed three groups: i) Mexico, Ecuador and Argentina 1 populations; ii) Bolivia and Peru populations; iii) Argentina 2 population. These differences were confirmed by sequencing the ITS rDNA region. Depth of branching was strongly supportive of the presence of three separate species, thus supporting the hypothesis that N. aberrans s.l. is indeed a species complex. The populations from Mexico, Ecuador and Argentina 1 are attributed to N. aberrans s.s., although this requires confirmation by molecular characterisation of N. aberrans from the type locality in the USA; those from Bolivia and Peru are attributed to N. bolivianus Lordello, Zamith & Boock, 1961 with Argentina 2 regarded as representing another taxon. Nacobbus serendipiticus and N. batatiformis are removed from synonymy under N. aberrans s.l . and regarded as species inquirendae . Consistent minor banding patterns in the RFLP profiles may indicate that the genus reproduces predominantly by parthenogenesis.
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O'Brien S, de Benoist AC, Brett M, Reid A, Evans B, Catchpole M, Mortimer P, Gregor S, White J. January to March 2002 - From the PHLS Communicable Disease Surveillance Centre. J Public Health (Oxf) 2002. [DOI: 10.1093/pubmed/24.3.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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166
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Viney R, Reid A. An alternative approach to fishbone extraction. JOURNAL OF THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH 2002; 47:515. [PMID: 12018699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We present a novel approach for a common ENT emergency. Under nasendoscopic guidance, a fishbone lodged in the pharynx can be removed with a suction catheter passed nasally.
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167
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Reid A. Target format and hybridization conditions. Methods Mol Biol 2002; 179:1-11. [PMID: 11692854 DOI: 10.1385/1-59259-238-4:001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Reid A. Random primed labeling. Methods Mol Biol 2002; 179:27-8. [PMID: 11692871 DOI: 10.1385/1-59259-238-4:027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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169
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170
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Roberts C, Jack F, Angus B, Reid A, Thompson WD. Immunohistochemical detection of CD30 remains negative in nodular lymphocyte-predominant Hodgkin's disease using enhanced antigen retrieval. Histopathology 2002; 40:166-70. [PMID: 11952861 DOI: 10.1046/j.1365-2559.2002.01338.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The aims of this study were to confirm that CD30 is reproducibly negative in cases of nodular lymphocyte-predominant Hodgkin's disease (nLPHD), and its relationship to further antibody targets for the distinction of L&H cells from classical Hodgkin's and Reed-Sternberg cells. METHODS AND RESULTS We examined 16 cases of nLPHD from two centres in the UK to characterize immunohistochemically L&H cells for CD30, EMA, J-chain and Oct2, using different methods of antigen retrieval, antigen amplification and antigen detection systems. Two cases could not be stained with J-chain and Oct2. All cases were negative for CD30 following manual and automated staining. Only one case became positive for EMA after manual staining using tyramide amplification. J-chain and Oct2 were negative in all cases following manual staining. J-chain showed a positive result of variable degree in all but one case using automated Dako ChemMate amplification system staining. Oct2 demonstrated a positive, albeit variable, staining pattern in all cases following automated staining. CONCLUSIONS CD30 remains negative in L&H cells of nLPHD using enhanced antigen retrieval and can therefore reliably be used to distinguish nLPHD from classical Hodgkin's disease. The value of EMA in the diagnosis of nLPHD remains uncertain, as it does not reproducibly mark L&H cells, even after the use of enhanced antigen retrieval. J-chain and Oct2 appear to be useful markers in the diagnosis of nLPHD using enhanced immunostaining and should therefore be included in lymphoma panels. Automated enhanced staining, using standardized protocols, precoated slides and the full system of prepared reagents, further diminishes the occurrence of errors associated with manual staining, and thereby improves confidence and reliability in diagnosing nLPHD.
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171
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Sturmberg JP, Reid A, Khadra MH. Community based medical education in a rural area: a new direction in undergraduate training. Aust J Rural Health 2001; 9 Suppl 1:S14-8. [PMID: 11998270 DOI: 10.1046/j.1440-1584.9.s1.6.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Greater Murray Clinical School provides a community based medical education programme for the clinical years at the University of New South Wales. Being a new clinica school in rural Australia allowed the development of a patient-centred longitudinal curriculum. Students follow patients through the health care system, with each exposure stimulating the learning about different aspects of a patient problem. The paper outlines the conceptual approach towards the development and implementation of this novel approach to community based medical education.
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172
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Reid A. Neonatal mortality and stillbirths in early twentieth century Derbyshire, England. POPULATION STUDIES 2001; 55:213-32. [PMID: 11778618 DOI: 10.1080/00324720127696] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Neonatal mortality and stillbirths are recognised to be subject to similar influences, but survival after a successful live birth is usually considered in isolation of foetal wastage. Moreover, individual-level data on age-specific influences and causes of death in a historical context are rare. This paper uses an unusual data set to compare the influences on neonatal mortality and stillbirths in early twentieth century Derbyshire, England. Multivariate hazard and logistic analyses are performed to examine the relative roles of various social, environmental, and demographic factors. The influences on and causal structures of neonatal mortality and stillbirths emerge as broadly similar, with previous reproductive history linked to a considerable amount of variation. The clustering of endogenous deaths was much greater than the clustering of exogenous and post-neonatal deaths, probably reflecting the cause-of-death structure and the relatively healthy social and environmental position of early twentieth century Derbyshire.
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Reid A, Gribble SM, Andrews KM, Green AR, Nacheva EP. Chromosome band specific FISH probes allow improved detection of terminal translocations in leukaemic metaphases. Leukemia 2001; 15:860-1. [PMID: 11368452 DOI: 10.1038/sj.leu.2402096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Reid A, Gribble SM, Huntly BJ, Andrews KM, Campbell L, Grace CD, Wood ME, Green AR, Nacheva EP. Variant Philadelphia translocations in chronic myeloid leukaemia can mimic typical blast crisis chromosome abnormalities or classic t(9;22): a report of two cases. Br J Haematol 2001; 113:439-42. [PMID: 11380413 DOI: 10.1046/j.1365-2141.2001.02778.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A range of fluorescent in situ hybridization techniques have been used to reveal hidden variant Philadelphia translocations in two cases of Ph-positive chronic-phase chronic myeloid leukaemia. In one patient, a highly complex variant Ph translocation affecting four chromosomes had resulted in the formation of structures with the appearance of i(17q) and +8. Misinterpretation of these karyotypes has direct clinical relevance. Our findings illustrate that even established cytogenetic abnormalities may contain cryptic abnormalities beyond the resolution of conventional cytogenetic methods.
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MESH Headings
- Aged
- Chromosome Banding
- Chromosomes, Human, Pair 1
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 9
- Diagnosis, Differential
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Metaphase
- Philadelphia Chromosome
- Translocation, Genetic
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Partridge C, Mackenzie M, Edwards S, Reid A, Jayawardena S, Guck N, Potter J. Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2001; 5:230-40. [PMID: 11129665 DOI: 10.1002/pri.203] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams. Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results. Physiotherapy is one component of most rehabilitation teams and recent systematic reviews have shown that patients with stroke receiving more physiotherapy achieve more recovery from disability. However, information about the actual amounts of physiotherapy needed to achieve this result is not known. METHOD A pragmatic, randomized, single-blind, controlled trial comparing recovery from disability in subjects receiving the current standard amount of 30 minutes' physiotherapy with those receiving double that amount (60 minutes). The study included measures of physical performance and function, psychological aspects of anxiety and depression, and perceived control over recovery. RESULTS Some 114 subjects were recruited to the study; full six-week data are available for 104 subjects and six-month data for 93 subjects. Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference. Scrutiny of the recovery curves of the whole sample showed that, in half the sample, three distinct patterns of recovery were demonstrated. CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients. The subgroup analysis of patterns of recovery must be regarded as speculative, but provides the basis for hypotheses about those likely to respond well to more intensive therapy.
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Thompson WD, Reid A. Quantitative assays for the chick chorioallantoic membrane. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2001; 476:225-36. [PMID: 10949668 DOI: 10.1007/978-1-4615-4221-6_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Focal application of angiogenic substances to the chick chorioallantoic membrane is quick and easy as a rapid screening test, but is susceptible to artefactual stimulation induced by carriers, hyperosmolarity, proteolytic activity, and indeed any cause of damage to the CAM. This can be deceptive and unanticipated. Focal application methods can be used for subsequent measurement by morphometry of the increased vascularity forming the typical spokewheel pattern of supply vessels. If test and control substances are applied in liquid form to the whole dropped CAM surface, then a much wider variety of quantitative morphometric, histological and biochemical techniques can be applied. Assessment of arterial vascularity, terminal arterial branching, supply vessels in cross-sections, and CAM haemoglobin content are direct measures of angiogenic effects, but are time-consuming. Biochemical assays of collagen, protein and DNA synthesis parallel the other assays, and these parameters can be estimated more quickly within the working week. There is inherent variability in the outbred strains of hen eggs currently commercially available. This means that all assays require substantial group numbers to achieve statistical validity, generally not less than 10 eggs per group. The biochemical assays yield interesting time-course patterns that distinguish between different types of angiogenic stimulants.
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Reid A. Understanding Melayu (Malay) as a source of diverse modern identities. JOURNAL OF SOUTHEAST ASIAN STUDIES 2001; 32:295-313. [PMID: 19192500 DOI: 10.1017/s0022463401000157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article attempts to bring together recent literature about the typology of nationalism, with the ways in which ‘Malay’ or ‘Melayu’ have been used as the core of an ethnie or a nationalist project. Different meanings of ‘Melayu’ were salient at different times in Sumatra, in the Peninsula and in the eastern Archipelago, and the Dutch and British used their respective translations of it very differently. Modern ethno-nationalist projects in Malaysia and Brunei made ‘Melayu’ a contested and often divisive concept, whereas its translation into the hitherto empty term ‘Indonesia’ might have provided an easier basis for territorial, or even ultimately civic, nationalism in that country.
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Warmington A, Hughes T, Walker J, Reid A, Pearson J. Cricothyroidotomy and transtracheal high frequency jet ventilation for elective laryngeal surgery. An audit of 90 cases--reply. Anaesth Intensive Care 2000; 28:711. [PMID: 11153313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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179
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Reid A, Lynskey M, Copeland J. Cannabis use among Australian adolescents: findings of the 1998 National Drug Strategy Household Survey. Aust N Z J Public Health 2000; 24:596-602. [PMID: 11215007 DOI: 10.1111/j.1467-842x.2000.tb00523.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the prevalence, context and recent trends in cannabis use among Australian adolescents. METHOD Data was collected from 1,581 adolescents aged 14-19 years as part of the 1998 National Drug Strategy Household Survey, and comparisons were made with data from 350 adolescents who participated in the 1995 survey. RESULTS Among 14-19 year olds, 47.8% have had the opportunity to use cannabis in the past year and 45.2% have used cannabis at least once in their lifetime. Substantial increases have occurred since 1995 in the prevalence of use among young females. While most cannabis use was fairly infrequent, a minority of 14-19 year olds (9.4%) used cannabis at least weekly. Cannabis use was associated with regular tobacco and alcohol use, and other illicit drug use. Regular cannabis users had lower levels of health on the general health and vitality dimensions of the SF-36. IMPLICATIONS These results show that cannabis availability and use is common among Australian adolescents, and confirm that there has been an increase in use between 1995 and 1998, although only among young females. Future research is required to understand why this recent increase has occurred, and trends in cannabis uptake and use patterns among this group should be carefully monitored. Interventions may need to be developed and made available to the group of young people who are using cannabis heavily.
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Stirk CM, Reid A, Melvin WT, Thompson WD. Locating the active site for angiogenesis and cell proliferation due to fibrin fragment E with a phage epitope display library. GENERAL PHARMACOLOGY 2000; 35:261-7. [PMID: 11888682 DOI: 10.1016/s0306-3623(01)00114-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The plasmin-mediated lysis of fibrin present in a wound, or in chronic inflammatory disease, results in the release of fibrin degradation products. One of the two major products is fibrin fragment E, which has been shown to stimulate cell proliferation in many cell types including endothelium, fibroblasts, and smooth muscle cells, and to be angiogenic in the chick chorioallantoic membrane (CAM) system. The activity of fibrin fragment E is dependent on N-terminus thrombin action. Antibodies against fibrin E, which block the cell proliferative activity, were used to locate the active site. Phage epitope display libraries were used to identify the sequence of a peptide, which resembles a region of the N terminus structure. The equivalent synthetic peptide (WTM110) has optimal stimulatory properties at equimolar concentrations to the parent molecule. Such peptide information has therapeutic potential for both stimulating and suppressing angiogenesis and cell proliferation.
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Wildgoose A, Waller G, Clarke S, Reid A. Psychiatric symptomatology in borderline and other personality disorders: dissociation and fragmentation as mediators. J Nerv Ment Dis 2000; 188:757-63. [PMID: 11093378 DOI: 10.1097/00005053-200011000-00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study considered the role of dissociation and personality fragmentation as psychological factors that might distinguish borderline and personality disorder (BPD) patients, and that might explain why BPD patients have higher levels of other psychiatric symptomatology than those with other personality disorders. Two groups of personality-disordered patients (personality disorders including BPD; personality disorders other than BPD) completed measures of dissociation, personality fragmentation, and psychiatric disturbance. The BPD group had higher levels of a number of aspects of psychiatric symptomatology. Those differences were mediated by aspects of dissociation. Personality fragmentation differentiated the two groups but was not related to the higher levels of other aspects of psychiatric disturbance. Treating the syndrome of BPD may depend on addressing both dissociation and personality fragmentation. In contrast, reducing the level of comorbid psychiatric disturbance in BPD is likely to be more strongly dependent on reducing levels of different aspects of dissociation. Psychotherapeutic techniques and targets for achieving such change are discussed.
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Abstract
Sensitivity encoding (SENSE) was used to improve the performance of three-dimensional contrast-enhanced magnetic resonance angiography (3D CE-MRA). Utilizing an array of receiver coils for sensitivity encoding, the encoding efficiency of gradient-echo imaging was increased by factors of up to three. The feasibility of the approach was demonstrated for imaging of the abdominal vasculature. On the one hand, using a SENSE reduction factor of two, the spatial resolution of a breath-hold scan of 17 seconds was improved to 1.0 x 2.0 x 2.0 mm(3). On the other hand, using threefold reduction, time-resolved 3D CE-MRA was performed with a true temporal resolution of 4 seconds, at a spatial resolution of 1.6 x 2.1 x 4.0 mm(3). CE-MRA with SENSE was performed in healthy volunteers and patients and compared with a standard protocol. Throughout, diagnostic quality images were obtained, showing the ability of sensitivity encoding to enhance spatial and/or temporal resolution considerably in clinical angiographic examinations.
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Wilkinson D, Newman W, Reid A, Squire SB, Sturm AW, Gilks CF. Trial-of-antibiotic algorithm for the diagnosis of tuberculosis in a district hospital in a developing country with high HIV prevalence. Int J Tuberc Lung Dis 2000; 4:513-8. [PMID: 10864181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To evaluate a diagnostic algorithm for pulmonary tuberculosis based on smear microscopy and objective response to trial of antibiotics. SETTING Adult medical wards, Hlabisa Hospital, South Africa, 1996-1997. METHODS Adults with chronic chest symptoms and abnormal chest X-ray had sputum examined for Ziehl-Neelsen stained acid-fast bacilli by light microscopy. Those with negative smears were treated with amoxycillin for 5 days and assessed. Those who had not improved were treated with erythromycin for 5 days and reassessed. Response was compared with mycobacterial culture. RESULTS Of 280 suspects who completed the diagnostic pathway, 160 (57%) had a positive smear, 46 (17%) responded to amoxycillin, 34 (12%) responded to erythromycin and 40 (14%) were treated as smear-negative tuberculosis. The sensitivity (89%) and specificity (84%) of the full algorithm for culture-positive tuberculosis were high. However, 11 patients (positive predictive value [PPV] 95%) were incorrectly diagnosed with tuberculosis, and 24 cases of tuberculosis (negative predictive value [NPV] 70%) were not identified. NPV improved to 75% when anaemia was included as a predictor. Algorithm performance was independent of human immunodeficiency virus status. CONCLUSION Sputum smear microscopy plus trial of antibiotic algorithm among a selected group of tuberculosis suspects may increase diagnostic accuracy in district hospitals in developing countries.
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Beesley R, Filteau S, Tomkins A, Doherty T, Ayles H, Reid A, Ellman T, Parton S. Impact of acute malaria on plasma concentrations of transferrin receptors. Trans R Soc Trop Med Hyg 2000; 94:295-8. [PMID: 10975004 DOI: 10.1016/s0035-9203(00)90329-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The acute-phase response to infection alters the plasma concentrations of most biochemical measures of iron status, rendering assessment of status difficult. Soluble transferrin receptors (TfR) may be an exception but have not been examined longitudinally during the major metabolic and inflammatory changes which occur during clinical malaria. Blood samples were collected daily during hospitalization, and again at a follow-up 2-6 weeks after discharge, from adult, mainly European, patients (n = 49) who developed uncomplicated Plasmodium falciparum malaria following visits to endemic areas. Parasitaemia and plasma concentrations of ferritin, TfR, C-reactive protein (CRP), alpha 1-acid glycoprotein (AGP) and alpha 1-antichymotrypsin (ACT) were measured. The concentrations of CRP, AGP and ACT correlated highly (P < 0.001) with each other and with plasma ferritin, and were significantly higher (P < 0.05) at all time points in hospital compared to the follow-up. TfR concentration correlated negatively and significantly (P < 0.05) with AGP and CRP but not with ACT or ferritin, and was significantly lower (around 30%) at all time points in hospital compared to follow-up, although in only 1 subject did it ever fall outside the normal reference range. In areas where both iron deficiency and clinical episodes of malaria are common, plasma TfR values need to be interpreted cautiously as indicators of iron status.
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Sawynok J, Reid A, Liu XJ. Involvement of mast cells, sensory afferents and sympathetic mechanisms in paw oedema induced by adenosine A(1) and A(2B/3) receptor agonists. Eur J Pharmacol 2000; 395:47-50. [PMID: 10781673 DOI: 10.1016/s0014-2999(00)00125-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Both the adenosine A(1) receptor agonist N(6)-cyclopentyladenosine and the adenosine A(2B/3) receptor agonist N(6)-benzyl-5'-N-ethylcarboxamido adenosine (N(6)-B-NECA) produce an acute paw oedema response following local s.c. injection into the rat hindpaw. This study characterized aspects of the mechanisms by which these responses occur by determining the effect of compound 48/80 (mast cell depleting agent), capsaicin (sensory neurotoxin) and 6-hydroxydopamine (sympathetic nervous system neurotoxin) on the paw oedema response produced by these agents. Compound 48/80 markedly reduced the increase in paw volume produced by both N(6)-cyclopentyladenosine and N(6)-B-NECA. Capsaicin significantly reduced paw oedema induced by N(6)-cyclopentyladenosine but not N(6)-B-NECA. In contrast, 6-hydroxydopamine reduced paw oedema induced by N(6)-B-NECA but not N(6)-cyclopentyladenosine. These results indicate an involvement of mast cells in paw oedema produced by both adenosine A(1) and A(2B/3) receptor agonists. For N(6)-cyclopentyladenosine, this involvement may be a secondary involvement due to activation of a neurogenic mechanism, but for N(6)-B-NECA, it may be a direct effect on mast cells. The nature of the involvement of the sympathetic nervous system in the action of N(6)-B-NECA is not entirely clear.
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Abstract
There is an increasing need to evaluate the costs and benefits of an occupational health service (OHS). However, measuring benefits from an OHS is inherently difficult. Instead, an economic model can be constructed to present the minimum threshold benefits required for OHSs to be cost-effective, given what is known about costs. This model assumes that the benefits of an OHS are to maximize health and morale of employees; maximize performance and increase productivity; minimize medico-legal costs; enhance workplace safety; and reduce sickness absence. A certain distribution across these benefits can be assumed for each OHS. The overall required value of all benefits brought about by use of an OHS is in the range 158-199 Pounds per year. The plausibility of results can be assessed using known data and judgement. Despite many uncertainties it is likely that the minimum benefit thresholds will be achieved overall.
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Sinclair PB, Nacheva EP, Leversha M, Telford N, Chang J, Reid A, Bench A, Champion K, Huntly B, Green AR. Large deletions at the t(9;22) breakpoint are common and may identify a poor-prognosis subgroup of patients with chronic myeloid leukemia. Blood 2000; 95:738-43. [PMID: 10648381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The hallmark of chronic myeloid leukemia (CML) is the BCR-ABL fusion gene, which is usually formed as a result of the t(9;22) translocation. Patients with CML show considerable heterogeneity both in their presenting clinical features and in the time taken for evolution to blast crisis. In this study, metaphase fluorescence in situ hybridization showed that a substantial minority of patients with CML had large deletions adjacent to the translocation breakpoint on the derivative 9 chromosome, on the additional partner chromosome in variant translocations, or on both. The deletions spanned up to several megabases, had variable breakpoints, and could be detected by microsatellite polymerase chain reaction in unfractionated bone marrow and purified peripheral blood granulocytes. The deletions were likely to occur early and possibly at the time of the Philadelphia (Ph) chromosome translocation: deletions were detected at diagnosis in 11 patients, were found in all Ph-positive metaphases, and were more prevalent in patients with variant Ph chromosomes. Kaplan-Meier analysis showed a median survival time of 36 months in patients with a deletion; patients without a detectable deletion survived > 90 months. The survival-time difference was significant on log-rank analysis (P =. 006). Multivariate analysis demonstrated that the prognostic importance of deletion status was independent of age, sex, percentage of peripheral blood blasts, and platelet count. Our data therefore suggest that an apparently simple, balanced translocation may result not only in the generation of a dominantly acting fusion oncogene but also in the loss of one or more genes that influence disease progression. (Blood. 2000;95:738-743)
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Steiner JF, Curtis P, Lanphear BP, Vu KO, Reid A. Program directors' perspectives on federally funded fellowship training in primary care research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2000; 75:74-80. [PMID: 10667881 DOI: 10.1097/00001888-200001000-00019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To describe the organization, models of training, and institutional impact of National Research Service Award fellowship programs in primary care research. METHOD Survey of 25 directors of currently-funded and former training sites. RESULTS Twenty-four program directors (96%) completed the survey. Programs allocated 39% of fellows' time to course work leading to an advanced degree or other didactic instruction, and 40% of time to the conduct of research. Collaborations with other training programs within the institution occurred at 83% of sites. Programs commonly (54%) or exclusively (42%) relied on a research model of "early research independence" in which the fellow defined an area of research interest, rather than an "apprenticeship" model in which the fellow worked in a senior investigator's research area. These programs enriched the local academic environment, but required extensive financial subsidies. The high costs of training often had adverse impacts on recruitment and other components of the training process. CONCLUSION Research training programs in primary care often substitute acquisition of advanced degrees for early immersion in research. The "early independence" model of research differs from fellowships in the medical specialties, and requires further study to assess its effectiveness. The need to subsidize training costs poses substantial problems for the institutions that host these fellowship programs.
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Sawynok J, Reid A, Liu XJ. Acute paw oedema induced by local injection of adenosine A(1), A(2) and A(3) receptor agonists. Eur J Pharmacol 1999; 386:253-61. [PMID: 10618477 DOI: 10.1016/s0014-2999(99)00752-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The present study used plethysmometry to examine oedema following local injection of selective adenosine A(1), A(2) and A(3) receptor agonists and inhibitors of adenosine metabolism into the hindpaw of the rat. N(6)-Cyclopentyladenosine and L-N(6)-phenylisopropyladenosine (A(1)), 2-[p(2-carboxyethyl) phenethylamino]-5'-N-ethylcarboxamidoadenosine hydrochloride (CGS21680) (A(2A)) and N(6)-benzyl-5'-N-ethylcarboxamido adenosine (N(6)-B-NECA) (A(3)) all produced an increase in paw volume (N(6)N(6)-cyclopentyladenosine, L-N(6)CGS21680). At the highest dose, each agent also produced a systemically mediated suppression of oedema. Oedema by N(6)-cyclopentyladenosine was blocked by caffeine, 8-cyclopentyl-1,3-dimethylxanthine and enprofylline. Oedema by CGS21680 was blocked by caffeine and 8-cyclopentyl-1, 3-dimethylxanthine. Oedema by N(6)-B-NECA was blocked by enprofylline, but not by caffeine or 8-cyclopentyl-1, 3-dimethylxanthine, or by systemic administration of MRS 1191. Oedema by both N(6)-cyclopentyladenosine and N(6)-B-NECA was blocked by mepyramine, ketanserin and phentolamine, but that by CGS21680 was not. The adenosine kinase inhibitor 5'-amino-5'-deoxyadenosine and the adenosine deaminase inhibitor 2'-deoxycoformycin produced only a limited increase in paw volume, and this was blocked by caffeine. This study demonstrates an acute paw oedema response following local administration of adenosine A(1), A(2) and A(3) receptor agonists, which likely results from different mechanisms of action in each case.
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dos Santos Silva I, Swerdlow AJ, Stiller CA, Reid A. Incidence of testicular germ-cell malignancies in England and Wales: trends in children compared with adults. Int J Cancer 1999; 83:630-4. [PMID: 10521799 DOI: 10.1002/(sici)1097-0215(19991126)83:5<630::aid-ijc11>3.0.co;2-m] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The incidence of testicular cancer has been increasing markedly in most industrialised countries. This rise is known to have affected young adults, but it is less clear whether it has affected other age groups, particularly children. We used data from the National Cancer Registry file at the Office of National Statistics (ONS) and the National Registry of Childhood Tumours to examine trends in testicular germ-cell malignancies overall in England and Wales from 1962 to 1990 and in children from 1962 to 1995. The incidence of testicular cancer at all ages rose by 3.4% (95% CI 3.3-3.6%) per annum from 1962 to 1990. A similar rise in the incidence of germ-cell malignancies occurred during the years for which histological information was available in the ONS files, 1971-1989 (3.4%; 3.1-3.6%), to which both seminomas and non-seminomas contributed equally. The incidence of non-seminomas in adults rose in men under age 55 years and declined in older men, whereas there were increases in the incidence of seminomas in both young and older men. Cohort analysis at young ages showed a marked rise in the risk of germ-cell malignancies up to the cohort born in 1955-1959 but no further rise for those born subsequently. The rise in the incidence of these tumours in young adults was paralleled by a similar trend, although less marked, in children aged under 15 years (1.3% per annum; 0.2-2.5%). The increase in risk for children in this very large data set alongside the rise in young adults is compatible with the hypothesis that childhood and adult testicular germ-cell malignancies may have some common risk factors, presumably pre-natal.
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Reid A, Willshaw D. Modeling prefrontal cortex delay cells: the role of dopamine in schizophrenia. PROGRESS IN BRAIN RESEARCH 1999; 121:351-73. [PMID: 10551036 DOI: 10.1016/s0079-6123(08)63083-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Thompson A, Reid A, Shields M, Steen H, Taylor R. Increased incidence in childhood empyema thoracis in Northern Ireland. IRISH MEDICAL JOURNAL 1999; 92:438. [PMID: 10967870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Connolly C, Reid A, Davies G, Sturm W, McAdam KP, Wilkinson D. Relapse and mortality among HIV-infected and uninfected patients with tuberculosis successfully treated with twice weekly directly observed therapy in rural South Africa. AIDS 1999; 13:1543-7. [PMID: 10465079 DOI: 10.1097/00002030-199908200-00015] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine post-treatment relapse and mortality rates among HIV-infected and uninfected patients with tuberculosis treated with a twice-weekly drug regimen under direct observation (DOT). SETTING Hlabisa, South Africa. PATIENTS A group of 403 patients with tuberculosis (53% HIV infected) cured following treatment with isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E) given in hospital (median 17 days), followed by HRZE twice weekly to 2 months and HR twice weekly to 6 months in the community under DOT. METHODS Relapses were identified through hospital readmission and 6-monthly home visits. Relapse (culture for Mycobacterium tuberculosis) and mortality given as rates per 100 person-years observation (PYO) stratified by HIV status and history of previous tuberculosis treatment. RESULTS Mean (SD) post-treatment follow-up was 1.2 (0.4) years (total PYO = 499); 78 patients (19%) left the area, 58 (14%) died, 248 (62%) remained well and 19 (5%) relapsed. Relapse rates in HIV-infected and uninfected patients were 3.9 [95% confidence interval (CI) 1.5-6.3] and 3.6 (95% CI 1.1-6.1) per 100 PYO (P = 0.7). Probability of relapse at 18 months was estimated as 5% in each group. Mortality was four-fold higher among HIV-infected patients (17.8 and 4.4 deaths per 100 PYO for HIV-infected and uninfected patients, respectively; P<0.0001). Probability of survival at 24 months was estimated as 59% and 81%, respectively. We observed no increase in relapse or mortality among previously treated patients compared with new patients. A positive smear at 2 months did not predict relapse or mortality. CONCLUSION Relapse rates are acceptably low following successful DOT with a twice weekly rifampicin-containing regimen, irrespective of HIV status and previous treatment history. Mortality is substantially increased among HIV-infected patients even following successful DOT and this requires further attention.
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Olojugba DH, McCarthy MJ, Reid A, Varty K, Naylor AR, Bell PR, London NJ. Infrainguinal revascularisation in the era of vein-graft surveillance--do clinical factors influence long-term outcome? Eur J Vasc Endovasc Surg 1999; 17:121-8. [PMID: 10063406 DOI: 10.1053/ejvs.1998.0720] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the variables affecting the long-term outcome of infrainguinal vein bypass grafts that have undergone postoperative surveillance. DESIGN A retrospective analysis. PATIENTS AND METHODS Details of 299 consecutive infrainguinal vein grafts performed in 275 patients from a single university hospital were collected and analysed. All grafts underwent postoperative duplex surveillance. Factors affecting patency, limb salvage and survival rates were examined. These factors were gender, diabetes, hypertension, aspirin, warfarin, ischaemic heart disease, run-off, graft type, early thrombectomy, level of anastomoses and indication for surgery. RESULTS The 6-year primary, primary assisted and secondary patency rates were 23, 47, and 57%, respectively. Six-year limb salvage and patient survival were 68 and 45%, respectively. Primary patency was adversely influenced by the use of composite vein grafts. Early thrombectomy was the only factor that significantly influenced secondary patency. Limb salvage was worse in diabetic limbs, limbs with poor run-off and in grafts that required early thrombectomy. Postoperative survival was better in males, claudicants and in patients who took aspirin. CONCLUSIONS Although co-morbid factors did not influence graft patency rates, diabetes did adversely effect limb salvage. This study, like others before it, confirms that aspirin significantly reduces long-term mortality in patients undergoing infrainguinal revascularisation.
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Richardson MP, Williamson TJ, Reid A, Tarlow MJ, Rudd PT. Otoacoustic emissions as a screening test for hearing impairment in children recovering from acute bacterial meningitis. Pediatrics 1998; 102:1364-8. [PMID: 9832570 DOI: 10.1542/peds.102.6.1364] [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: 11/24/2022] Open
Abstract
OBJECTIVES To study the efficacy of otoacoustic emissions (OAEs) as a screening test for hearing impairment in children with acute bacterial meningitis. Hearing tests were performed before discharge from the hospital in an attempt to improve coverage and avoid delays in the diagnosis of postmeningitic hearing loss. METHODS Children with bacterial meningitis were recruited from 21 centers. In the 48 hours before discharge from the hospital, all patients underwent a thorough audiologic assessment consisting of transient evoked OAEs, auditory brainstem responses (ABRs), otoscopy, and tympanometry. Hearing loss was defined as ABR threshold >/=30 dB. The results of OAE screening were compared with the gold standard of ABR threshold. RESULTS Of 124 children recruited, we were able to perform both OAEs and ABRs on 110 children. Seven (6.3%) of the 110 children had ABR threshold >/=30 dB; 2 had sensorineural hearing loss and 5 had conductive hearing loss. At follow-up, hearing loss persisted in both cases of sensorineural hearing loss and no new cases were identified. All 7 children with hearing loss failed the OAE screening test. Ninety-four children with normal hearing thresholds passed the test, and 9 failed. Thus, the screening test had a sensitivity of 1.00 (95% confidence interval, 0.59 to 1.00), a specificity of 0.91 (0.85 to 0.97), a positive predictive value of 0. 44 (0.20 to 0.70), and a negative predictive value of 1.00 (0.96 to 1.00). CONCLUSIONS OAE screening in children recovering from meningitis was found to be feasible and effective. The test was highly sensitive and reasonably specific. Inpatient OAE screening should allow early diagnosis of postmeningitic hearing loss and prompt auditory rehabilitation.
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MESH Headings
- Acute Disease
- Adolescent
- Child
- Child, Preschool
- Evoked Potentials, Auditory, Brain Stem
- Feasibility Studies
- Hearing Loss/diagnosis
- Hearing Loss/etiology
- Hearing Loss/physiopathology
- Hearing Loss, Conductive/diagnosis
- Hearing Loss, Conductive/etiology
- Hearing Loss, Conductive/physiopathology
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Humans
- Infant
- Meningitis, Bacterial/complications
- Multicenter Studies as Topic
- Otoacoustic Emissions, Spontaneous
- Prospective Studies
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Lawrie SM, Martin K, McNeill G, Drife J, Chrystie P, Reid A, Wu P, Nammary S, Ball J. General practitioners' attitudes to psychiatric and medical illness. Psychol Med 1998; 28:1463-1467. [PMID: 9854287 DOI: 10.1017/s0033291798007004] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND General practitioners are increasingly involved in the care of patients with long-term psychiatric disorders. We have previously reported that general practitioners are less willing to treat patients with schizophrenia than those without such a diagnosis, but this may have been attributable to a reluctance to treat patients with any psychiatric or chronic illness. We, therefore, examined general practitioners' attitudes to patients with chronic psychiatric or medical illnesses. METHODS A random sample of 260 local general practitioners were each sent one of our case vignettes which were identical apart from mention of a previous diagnosis of schizophrenia, depression, diabetes or no illness. The general practitioners were asked to indicate their level of agreement with 13 attitudinal statements based on the vignette. RESULTS One hundred and sixty-six (66%) of the general practitioners responded to the case vignettes. Those responding to the vignette about the patient with schizophrenia were less happy to have that patient on their practice list and were more concerned about the risk of violence and the child's welfare. Those responding to the depression vignette were more likely to offer the patient antidepressants or counselling; and those who replied to the diabetes case were most likely to refer the patient to a hospital specialist. These differences were not attributable to the personal or practice characteristics of the general practitioners. CONCLUSIONS Patients with schizophrenia arouse concerns in general practitioners that are not simply due to those patients suffering from a psychiatric or chronic illness. Our results suggest that some patients with schizophrenia may find it difficult to register with a general practitioner and receive the integrated community-based health care service they require. Psychiatrists should provide education and support to general practitioners who look after patients with schizophrenia.
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Innes NJ, Reid A, Halstead J, Watkin SW, Harrison BD. Psychosocial risk factors in near-fatal asthma and in asthma deaths. JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 1998; 32:430-4. [PMID: 9819735 PMCID: PMC9663111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND A description of near-fatal asthma (NFA) and comparison with patients who died of asthma in an English health district between 1988 and 1995. METHODS The hospital case notes of patients aged under 65 years with NFA, identified from the intensive therapy unit register, were reviewed using forms based on those of the East Anglian confidential asthma death enquiry. Details were compared with patients dying from asthma in the same population during the same period. RESULTS Between 1988 and 1995, 19 patients suffered 23 episodes of NFA and 44 died from asthma. Those with NFA were significantly younger. There were more women in both groups. Two patients with NFA subsequently died of asthma. Significantly more patients with NFA had had a previous NFA episode than those who died. Five had a cardio-respiratory arrest. Thirteen required intermittent positive pressure ventilation (IPPV). PaCO2 ranged from 6.1 to 17.8 kPa; nine had PaCO2 > or = 10 kPa and three recovered without IPPV. Adverse psychological and social factors were similar in both groups. Denial was the commonest psychological factor and domestic, financial or employment stress, smoking or passive smoking the commonest adverse social factors; only two with NFA and seven who died had no recorded adverse psychological or social factors. CONCLUSIONS NFA and deaths from asthma occur in asthmatics who have many psychosocial risk factors in common. Special attention needs to be directed at patients with these adverse psychosocial factors, emphasising that they need continued follow-up with support to help them manage their asthma according to currently recommended practice.
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Brown K, Reid A, White T, Henderson T, Hukin S, Johnstone C, Glen A. Vitamin E, lipids, and lipid peroxidation products in tardive dyskinesia. Biol Psychiatry 1998; 43:863-7. [PMID: 9627739 DOI: 10.1016/s0006-3223(97)00197-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lipid peroxidation has been postulated as a possible mechanism for neuronal damage in tardive dyskinesia, and this is supported by evidence of increased lipid peroxidation products in the cerebrospinal fluid of dyskinetic subjects. METHODS In this study plasma levels of vitamin E and vitamin A, measured by high-performance liquid chromatography, and of thiobarbituric acid-reactive substances (TBARS), were determined in 16 schizophrenic patients with tardive dyskinesia, 16 nondyskinetic patients all assessed by Abnormal Involuntary Movement Scale (AIMS), and 10 normal control subjects. Plasma cholesterol and triglyceride were also measured throughout. Vitamin E levels in plasma were corrected for total lipids. RESULTS Multivariate analysis of covariance showed significant differences when vitamin E and TBARS were compared in the three groups. Univariate t tests showed a significantly lower lipid-corrected vitamin E (p = .018) between the normal and dyskinetic group but not between the normal and the nondyskinetic schizophrenic patients. There was no difference in vitamin A levels between patients and normal controls. TBAR results showed a significant positive correlation between AIMS score and lipid-corrected TBARS. CONCLUSIONS This study confirms an abnormality associating lipid peroxidation and tardive dyskinesia and extends this abnormality to measurements of lipid-corrected vitamin E in plasma.
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Loftus IM, Reid A, Thompson MM, London NJ, Bell PR, Naylor AR. The increasing workload required to maintain infrainguinal bypass graft patency. Eur J Vasc Endovasc Surg 1998; 15:337-41. [PMID: 9610347 DOI: 10.1016/s1078-5884(98)80038-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To assess the impact upon the provision of a vascular service of the workload associated with maintaining infrainguinal bypass graft patency. DESIGN A computerised prospective audit. MATERIALS AND METHODS Between January 1990 and December 1995, all patients with infrainguinal bypass grafts were entered into a prospective computerised audit to monitor interventions for the maintenance of graft patency. Excluded from the study were interventions during the first 30 postoperative days and procedures not directly related to the graft. A graft surveillance programme was in operation throughout. RESULTS During the study period a total of 131 patients with 144 grafts were admitted on 330 occasions and required 401 separate interventional procedures. There were 227 procedures in 72 femorodistal grafts, 116 in 38 below-knee femoropopliteal grafts and 58 interventions in the group of 34 above-knee femoropopliteal grafts. Radiological interventions accounted for almost 70% of this workload. CONCLUSION The workload associated with the maintenance of infrainguinal bypass grafts increased considerably during the study period, and seems likely to increase further. Such interventions should therefore be considered when planning for vascular service provision.
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Pemberton M, Reid A, London NJ, Bell PR, Naylor AR. Carotid endarterectomy is safe in selected elderly patients. Br J Surg 1998; 85:507. [PMID: 9607533 DOI: 10.1046/j.1365-2168.1998.00635.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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