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Crooks MG, Cummings H, Morice AH, Sykes D, Brooks S, Jackson A, Xu Y. Reducing short-acting beta-agonist use in asthma: Impact of national incentives on prescribing practices in England and the findings from SENTINEL Plus early adopter sites. NPJ Prim Care Respir Med 2024; 34:6. [PMID: 38684652 PMCID: PMC11058200 DOI: 10.1038/s41533-024-00363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
Short-acting beta-agonist (SABA) over-use in asthma is harmful for patients and the environment. The Investment and Impact Fund (IIF) 2022/2023 financially rewarded English primary care networks that achieved specific targets, including reducing SABA over-use (RESP-02) and lowering the mean carbon footprint per salbutamol inhaler prescribed (ES-02). SENTINEL Plus is a co-designed quality improvement package that aims to improve asthma outcomes and reduce asthma's environmental impact by addressing SABA over-use. We investigated the impact of (i) the IIF incentives and (ii) SENTINEL Plus implementation on asthma prescribing. Using Openprescribing.net data, we demonstrate that IIF 2022-2023 had no significant impact on the total number of SABA prescribed in England (25,927,252 during 12-months pre- and 25,885,213 12-months post-IIF; 0.16% decrease; p=NS), but lower carbon footprint SABA inhaler use increased (Salamol™ prescribing increased from 5.1% to 19% of SABA prescriptions, p < 0.01). In contrast, SENTINEL Plus sites significantly reduced SABA prescribing post-implementation (5.43% decrease, p < 0.05).
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Affiliation(s)
- M G Crooks
- Hull York Medical School, University of Hull, Hull, UK.
- Hull University Teaching Hospitals NHS Trust, Hull, UK.
| | - H Cummings
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - A H Morice
- Hull York Medical School, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - D Sykes
- Hull York Medical School, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - S Brooks
- Medical Affairs, AstraZeneca, London, UK
| | - A Jackson
- Medical Affairs, AstraZeneca, London, UK
| | - Y Xu
- Medical Affairs, AstraZeneca, London, UK
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2
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Goings B, Iglesias-McElwee C, Le BV, Keller K, Sykes D, Brewer R. Frontline Perspectives from the Implementation of Evidenced-Informed Interventions to Improve Behavioral Health and HIV Outcomes Among Black Men Who Have Sex with Men in the United States. AIDS Patient Care STDS 2022; 36:S36-S45. [PMID: 36178387 DOI: 10.1089/apc.2022.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The perspectives and contributions of frontline staff are critical to the success of integrated HIV and behavioral health services in the United States (US). In this analytic essay, we share five key priority areas from frontline staff at four diverse sites funded by the Health Resources and Services Administration to support the implementation of interventions to improve HIV and behavioral health outcomes among Black men who have sex with men (BMSM) living with HIV. The five main priorities focused on: (1) COVID-19 pandemic adaptations; (2) recruitment/enrollment; (3) retention; (4) frontline self-care; and (5) replication considerations. Projects had to be nimble and innovative in their delivery of services; leverage existing infrastructure; and they had to try multiple approaches to reach BMSM and modify/drop them as needed. Future implementers should expect to support frontline staff self-care given the added stress of working under COVID-19 pandemic conditions and in communities with limited and uncoordinated behavioral health services.
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Affiliation(s)
| | | | | | | | | | - Russell Brewer
- Biological Sciences Division, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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3
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Karunaratne A, Xi L, Bentley L, Sykes D, Boyde A, Esapa CT, Terrill NJ, Brown SDM, Cox RD, Thakker RV, Gupta HS. Multiscale alterations in bone matrix quality increased fragility in steroid induced osteoporosis. Bone 2016; 84:15-24. [PMID: 26657825 PMCID: PMC4764652 DOI: 10.1016/j.bone.2015.11.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 10/30/2015] [Accepted: 11/27/2015] [Indexed: 12/31/2022]
Abstract
A serious adverse clinical effect of glucocorticoid steroid treatment is secondary osteoporosis, enhancing fracture risk in bone. This rapid increase in bone fracture risk is largely independent of bone loss (quantity), and must therefore arise from degradation of the quality of the bone matrix at the micro- and nanoscale. However, we lack an understanding of both the specific alterations in bone quality n steroid-induced osteoporosis as well as the mechanistic effects of these changes. Here we demonstrate alterations in the nanostructural parameters of the mineralized fibrillar collagen matrix, which affect bone quality, and develop a model linking these to increased fracture risk in glucocorticoid induced osteoporosis. Using a mouse model with an N-ethyl-N-nitrosourea (ENU)-induced corticotrophin releasing hormone promoter mutation (Crh(-120/+)) that developed hypercorticosteronaemia and osteoporosis, we utilized in situ mechanical testing with small angle X-ray diffraction, synchrotron micro-computed tomography and quantitative backscattered electron imaging to link altered nano- and microscale deformation mechanisms in the bone matrix to abnormal macroscopic mechanics. We measure the deformation of the mineralized collagen fibrils, and the nano-mechanical parameters including effective fibril modulus and fibril to tissue strain ratio. A significant reduction (51%) of fibril modulus was found in Crh(-120/+) mice. We also find a much larger fibril strain/tissue strain ratio in Crh(-120/+) mice (~1.5) compared to the wild-type mice (~0.5), indicative of a lowered mechanical competence at the nanoscale. Synchrotron microCT show a disruption of intracortical architecture, possibly linked to osteocytic osteolysis. These findings provide a clear quantitative demonstration of how bone quality changes increase macroscopic fragility in secondary osteoporosis.
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Affiliation(s)
- A Karunaratne
- Queen Mary University of London, School of Engineering and Material Science, Mile End Road, London E1 4NS, UK.
| | - L Xi
- Queen Mary University of London, School of Engineering and Material Science, Mile End Road, London E1 4NS, UK.
| | - L Bentley
- MRC Mammalian Genetics Unit and Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, OX11 0RD, UK.
| | - D Sykes
- Core Research Laboratories, The Natural History Museum, London SW7 5BD, UK.
| | - A Boyde
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Institute of Dentistry, E1 2AD, UK.
| | - C T Esapa
- MRC Mammalian Genetics Unit and Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, OX11 0RD, UK; Academic Endocrine Unit, Nuffield Department of Clinical Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Headington, Oxford OX3 7JL, UK.
| | - N J Terrill
- Diamond Light Source Ltd., Beamline I22, Diamond House, Harwell Science and Innovation Campus, Chilton, Didcot, Oxfordshire, OX11 0DE, UK; Department of Chemistry, University of Sheffield, Dainton Building, Brookhill, Sheffield S3 7HF, UK.
| | - S D M Brown
- MRC Mammalian Genetics Unit and Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, OX11 0RD, UK.
| | - R D Cox
- MRC Mammalian Genetics Unit and Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, OX11 0RD, UK.
| | - R V Thakker
- Academic Endocrine Unit, Nuffield Department of Clinical Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Headington, Oxford OX3 7JL, UK.
| | - H S Gupta
- Queen Mary University of London, School of Engineering and Material Science, Mile End Road, London E1 4NS, UK.
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Mojica WD, Oh KW, Lee H, Furlani EP, Sykes D, Sands AM. Microfluidics enables multiplex evaluation of the same cells for further studies. Cytopathology 2015; 27:277-83. [DOI: 10.1111/cyt.12255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 12/22/2022]
Affiliation(s)
- W. D. Mojica
- Department of Pathology and Anatomical Sciences University at Buffalo Buffalo NY USA
| | - K. W. Oh
- Department of Electrical Engineering University at Buffalo Buffalo NY USA
| | - H. Lee
- Department of Electrical Engineering University at Buffalo Buffalo NY USA
| | - E. P. Furlani
- Department of Chemical and Biological Engineering University at Buffalo Buffalo NY USA
| | - D. Sykes
- Department of Medicine University at Buffalo Buffalo NY USA
| | - A. M. Sands
- Department of Pathology and Anatomical Sciences University at Buffalo Buffalo NY USA
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Haig C, Hursthouse A, Mcilwain S, Sykes D. An empirical investigation into the influence of pressure drop on particle behaviour in small scale reverse-flow cyclones. POWDER TECHNOL 2015. [DOI: 10.1016/j.powtec.2015.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Patterson CC, McCrum E, McMaster D, Kerr M, Sykes D, Evans AE. Factors influencing total cholesterol and high-density lipoprotein cholesterol concentrations in a population at high coronary risk. Acta Med Scand Suppl 2009; 728:150-8. [PMID: 3202024 DOI: 10.1111/j.0954-6820.1988.tb05567.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Serum total cholesterol and high-density lipoprotein (HDL) cholesterol concentrations were measured in 1122 men and 1147 women aged between 25 and 64 years during the first Belfast MONICA survey, and the results subjected to multiple regression analysis. In both men and women, total cholesterol increased with age. Although HDL-cholesterol showed little variation with age, the values were considerably higher in women than men. Total cholesterol increased with body mass index while HDL-cholesterol decreased, and these findings persisted after adjustment for age. Regular exercise was associated with higher HDL-cholesterol values, even after adjustment for age and body mass index. Among men and women who abstained from alcohol, lower values of HDL-cholesterol were observed. In both sexes, cigarette smoking was associated with significant increases in total cholesterol values and decreases in HDL-cholesterol values, though some of these findings became apparent only after adjustment for other relevant factors. Perhaps surprisingly, a measure of health knowledge showed no association with blood lipid concentrations.
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Affiliation(s)
- C C Patterson
- Belfast MONICA Project, Department of Community Medicine & Medical Statistics, Queen's University of Belfast Northern Ireland
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Hoffmann WC, Walker TW, Fritz BK, Gwinn T, Smith VL, Szumlas D, Quinn B, Lan Y, Huang Y, Sykes D. Spray characterization of thermal fogging equipment typically used in vector control. J Am Mosq Control Assoc 2008; 24:550-559. [PMID: 19181064 DOI: 10.2987/08-5779.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Droplet size spectra from different sprayers used to generate insecticide-laden fogs for controlling flying insects were measured by a laser diffraction instrument and Teflon-coated slides. The objectives of this work were to present not only information on spray-system droplet size generated by different sprayers, but to compare methodologies by which other similar systems can be evaluated and give applicators sprayer-system performance data. Data from 45 replicated spray tests, comprising 11 sprayers and 5 pesticides, showed a wide range in the droplet size spectra produced. The volume median diameter measurements ranged from 2.6 to 75.5 microm for diesel-diluted sprays and from 27.9 to 59.9 microm for water-diluted sprays. Similarly, the percent volume <20 microm ranged between 12.0-100% and 8.5-30.7%, for diesel- and water-diluted sprays, respectively. The droplet sizes measured by the swinging slide and laser diffraction methods were not consistent. The information presented aids users in sprayer selection and operation to produce the specific droplet size spectra required for a particular application.
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Affiliation(s)
- W C Hoffmann
- USDA-ARS-Areawide Pest Management Research Unit, 2771 F&B Road, College Station, TX 77845, USA
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Jakob F, Marín F, Martín-Mola E, Torgerson D, Fardellone P, Adami S, Thalassinos NC, Sykes D, Melo-Gomes J, Chinn C, Nicholson T, Cooper C. Characterization of patients with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO). QJM 2006; 99:531-43. [PMID: 16861718 DOI: 10.1093/qjmed/hcl073] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Osteoporotic fractures remain a major public health problem. Currently available osteoporosis therapies significantly reduce the risk of fractures, but up to 50% of patients have an inadequate clinical outcome to therapy. AIM To describe the clinical and quality of life (QOL) of a study population meeting a proposed definition of inadequate clinical outcome to osteoporosis therapy, recruited for the Observational Study of Severe Osteoporosis (OSSO). DESIGN Cross-sectional, observational study. METHODS Post-menopausal women with osteoporosis (n = 2314) were divided into Group 1 (those who had previously experienced a fragility fracture despite osteoporosis drug therapy for at least 12 months) (n = 1309, 57%), or Group 2 (those who had previously discontinued osteoporosis drug therapy due to non-compliance or side-effects) (n = 1005; 43%). Baseline clinical characteristics, quality of life (QOL) and osteoporosis/falls risk factors were analysed. RESULTS The overall population had low BMD (mean +/- SD T-score at lumbar spine -3.1 +/- 1.1), and risk factors for fracture such as previous fractures (67.8%), family history (15.1%), and prolonged glucocorticoid use (17.5%). QOL was poor: total QUALEFFO and EQ-5D scores were 46.8 +/- 18.7, and 0.50 +/- 0.33, respectively. Patients in Group 1 had higher age and body mass index, fewer hours of exercise, more previous fragility fractures and falls, and poorer QOL scores. DISCUSSION Our definition of inadequate clinical outcome from osteoporosis drug therapy identifies a severe osteoporosis cohort with poor QOL and increased fracture risk. Using such a definition may lead to earlier recognition of inadequate clinical outcome to osteoporosis therapy, and improved interventions and results.
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Affiliation(s)
- F Jakob
- Orthopaedic Department, Julius-Maximilians-Universität, Wurzburg, Germany
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Lundkvist J, Johnell O, Cooper C, Sykes D. Economic evaluation of parathyroid hormone (PTH) in the treatment of osteoporosis in postmenopausal women. Osteoporos Int 2006; 17:201-11. [PMID: 16027955 DOI: 10.1007/s00198-005-1959-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2004] [Accepted: 05/23/2005] [Indexed: 12/21/2022]
Abstract
Parathyroid hormone (PTH) is a new treatment for osteoporosis and has been shown to reduce the risks of vertebral and non-vertebral fractures in postmenopausal women in clinical trials. The objective of this study was to estimate the cost-effectiveness of teriparatide in addition to calcium and vitamin D, using a simulation model. The base case analysis was conducted for a cohort of 69-year-old women in Sweden who had at least one previous vertebral fracture and low bone mineral density. The model simulated the course of events in 6-month cycles in individual patients until death or 100 years of age. During each cycle the patients were at risk of experiencing clinical vertebral, hip or wrist fractures, or death. Total accumulated life-time costs and quality-adjusted life years (QALYs) were estimated. Swedish data on fracture costs, utility reductions after fracture, fracture risks and mortality rates were used. The model incorporated new epidemiological evidence that indicates fracture risks and mortality rates are higher in the subsequent years post-fracture. The results showed that the cost-effectiveness of the treatment is highly dependant on the risk profile of the treated patients and the timing of starting treatment relative to previous fractures. The cost per QALY gained for treatment of a population of 69-year-olds with a T-score at the femoral neck of -3 was in the base case estimated to be between EUR (euro) 20,000 and 64,000 for patients with a recent or historic vertebral fracture respectively. The study provides further evidence of the benefit and cost-effectiveness of starting osteoporotic treatments early in patients with a new fracture, and also that teriparatide may provide valuable clinical benefits for these patients and may be considered a cost-effective intervention when targeted to the appropriate patients.
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Affiliation(s)
- J Lundkvist
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
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10
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Cantillon M, Vause E, Sykes D, Tagoe M. Safety, tolerability and efficacy of intraoperative ALGRX 4975 in a randomized, double-blind, placebo-controlled study of subjects undergoing bunionectomy. The Journal of Pain 2005. [DOI: 10.1016/j.jpain.2005.01.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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O'Donnell M, Lose G, Sykes D, Voss S, Hunskaar S. Help-Seeking Behaviour and Associated Factors among Women with Urinary Incontinence in France, Germany, Spain and the United Kingdom. Eur Urol 2005; 47:385-92; discussion 392. [PMID: 15716205 DOI: 10.1016/j.eururo.2004.09.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Accepted: 09/27/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the proportion of women who consult their doctor about urinary incontinence (UI), and explore factors associated with help-seeking in France, Germany, Spain and the UK. METHODS A representative sample of 29,500 women received a 13 item postal questionnaire to identify those with UI. A randomly selected sub-sample of 2953 women with UI received a more detailed follow-up questionnaire. RESULTS There was a response rate of 58% in the initial survey and 53% in the second. Thirty-one percent of all women had consulted a doctor about their UI symptoms with more women consulting in France and Germany than in the UK and Spain. A number of factors relating to general health care, UI and women's attitudes were found to be associated with help-seeking after adjusting for women's age, UI duration and frequency, and 'bothersomeness' of UI; factors traditionally associated with help-seeking. After adjusting for these factors, willingness to take long-term medication and having spoken to others about UI were found to be strong predictors of help-seeking in all four countries.
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Affiliation(s)
- M O'Donnell
- Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway.
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12
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Kanis JA, Borgström F, Johnell O, Oden A, Sykes D, Jönsson B. Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int 2005; 16:15-25. [PMID: 15672210 DOI: 10.1007/s00198-004-1688-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Accepted: 06/04/2004] [Indexed: 10/26/2022]
Abstract
Raloxifene treatment has been shown to reduce the risk of vertebral fractures and breast cancer in postmenopausal women. The long-term economic implications of treatment with raloxifene have not yet been investigated. The aim of this study was to assess the cost-effectiveness of treating postmenopausal women in the UK with raloxifene. A previously developed computer simulation model was used to estimate the cost-effectiveness of osteoporotic treatments with extra skeletal benefits. The model was populated with epidemiological data and cost data relevant for a UK female population. Data on the effect of treatment were taken from the Multiple Outcomes of Raloxifene (MORE) study, which recruited women with low bone mineral density or with a prior vertebral fracture. Cost-effectiveness was estimated using Quality Adjusted Life Years (QALYs) and life years gained as primary outcome measures. The cost per QALY gained of treating postmenopausal women without prior vertebral fractures was 18,000 pounds, 23,000 pounds , 18,000 pounds and 21,000 pounds at 50, 60, 70 and 80 years of age. Corresponding estimates for women with prior vertebral fractures were 10,000 pounds, 24,000 pounds, 18,000 pounds and 20,000 pounds. In relation to threshold values that are recommended in the UK, the analysis suggests that raloxifene is cost-effective in the treatment of postmenopausal women at an increased risk of vertebral fractures.
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Affiliation(s)
- J A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
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13
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Abstract
BACKGROUND Vertebral fractures are associated with a reduction in quality of life and are an important predictor of other non-spine fractures. Previous work has shown that up to 60% of patients with a vertebral fracture identified in primary care remain untreated. OBJECTIVE To examine the prevalence of pharmaceutical treatment and predictors of treatment in a primary care setting. METHODS Case-control study using the general practice research database (GPRD). All women aged 50 years and over with a first diagnosis of a vertebral fracture since 1990 were identified and matched with a control by age and practice. Appropriate use of a pharmaceutical agent was defined as a prescription occurring within 30 days of the diagnosis being recorded. RESULTS We identified 2719 women with the same number of controls. Within 30 days of diagnosis 61% of women were prescribed treatment, compared with only 3% of the controls. Bisphosphonate was the single most important treatment prescribed. Predictors of any drug treatment included: year of fracture (most recent year increased the likelihood of treatment); age (younger patients were more likely to receive treatment); history of back pain; low body weight; history of steroid use. CONCLUSIONS Treatment of diagnosed vertebral fractures is becoming more common. Treated patients tend to be younger but to have a higher prevalence of clinical risk factors than untreated patients. There remain significant numbers of patients who are not offered treatment.
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Affiliation(s)
- D J Torgerson
- Department of Health Sciences, University of York, York YO10 5DD.
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Abstract
OBJECTIVE To determine the prevalence, type and treatment behaviour of women with urinary incontinence in four European countries. SUBJECTS AND METHODS Data were collected using a postal survey which was sent to 29,500 community-dwelling women aged > or = 18 years in France, Germany, Spain and the UK. Subjects were asked about the type of urinary incontinence they had experienced and their treatment behaviour. RESULTS Of the women who responded, 35% reported involuntary loss of urine in the preceding 30 days; stress urinary incontinence was the most prevalent type. The lowest prevalence was in Spain (23%), while the prevalence was 44%, 41% and 42% for France, Germany and the UK, respectively. About a quarter of women with urinary incontinence in Spain (24%) and the UK (25%) had consulted a doctor about it; in France (33%) and Germany (40%) the percentages were higher. Overall, <5% of the women had ever undergone surgery for their condition. While pads were used by half of the women, there were some differences among the countries. CONCLUSIONS Millions of women in Europe have urinary incontinence; the consultation and treatment rates were low in the European countries included in this study.
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Affiliation(s)
- S Hunskaar
- Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Norway.
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Abstract
BACKGROUND The objective of this study was to evaluate the cost-effectiveness of women undergoing IVF treatment with recombinant FSH (rFSH) in comparison with highly purified urinary FSH (uFSH-HP) and human menopausal gonadotrophins (HMG). METHODS A decision-analytic model was used to estimate cost-effectiveness ratios for 'the average cost per ongoing pregnancy' and 'incremental cost per additional pregnancy' for women entering into IVF treatment for a maximum of three cycles. The model was constructed based on a previously published large prospective randomized clinical trial comparing rFSH and uFSH-HP. Where necessary, these data were augmented with a combination of expert opinion, evidence from the literature and observational data relating to the management and cost of IVF treatment in the UK. The cost of rFSH, uFSH-HP and HMG were obtained from National Health Service list prices in the UK. RESULTS The model predicted a cumulative pregnancy rate after three cycles of 57.1% for rFSH and 44.4% for both uFSH-HP and HMG. The cost of IVF treatment was 5135 pounds sterling for rFSH, 4806 pounds sterling for uFSH-HP and 4202 pounds sterling for HMG. When assessed in association with outcomes, the average cost per ongoing pregnancy was more favourable with rFSH (8992 pounds sterling) than with either uFSH-HP (10 834 pounds sterling) or HMG (9472 pounds sterling). The incremental cost per additional pregnancy was 2583 pounds sterling using rFSH instead of uFSH-HP and 7321 pounds sterling using rFSH instead of HMG. These results were robust to changes in the baseline assumptions of the model. CONCLUSION rFSH is a cost-effective treatment strategy in ovulation induction prior to IVF.
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Affiliation(s)
- D Sykes
- Organon Laboratories, Cambridge Science Park, Milton Road, Cambridge CB4 0FL, UK
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16
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Sykes D. Medico-legal aspect of dental implants. Ann R Australas Coll Dent Surg 2000; 15:309-14. [PMID: 11709962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The practising environment in health care is ever changing in both clinical and management areas. Within dentistry, two major changes have occurred with the development of implantology into a sound treatment approach and a burgeoning of dental litigation. There are medico-legal issues that relate to dental implant treatment with which clinicians must become familiar and there are medico-legal implications that impact on risk management by Medical Indemnity Organizations (MDOs) and the indemnity premiums they set for their members. The aim of this paper is to discuss these issues and highlight those areas of significance to clinicians.
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Ambrus J, Ambrus C, Sykes D, Dembinski W, Bardos T, Ambrus J, Lilie D, Aradi J. The interferon system in lung cancer patients and new therapeutic approaches. Lung Cancer 1999. [DOI: 10.1016/s0169-5002(99)90724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Ciociola AA, McSorley DJ, Turner K, Sykes D, Palmer JB. Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated. Am J Gastroenterol 1999; 94:1834-40. [PMID: 10406244 DOI: 10.1111/j.1572-0241.1999.01214.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Published studies have estimated the rate of Helicobacter pylori (H. pylori) infection in patients with duodenal ulcer disease to be as high as 95%; the majority of remaining duodenal ulcers have been attributed to the use of ulcerogenic drugs such as nonsteroidal antiinflammatory drugs (NSAIDs). We aimed to assess the H. pylori prevalence rates of U.S. duodenal ulcer patients in large, well-controlled studies. METHODS More than 2900 patients with endoscopically diagnosed non-NSAID duodenal ulcers were enrolled in a series of six placebo-controlled, double-blind studies conducted in the United States that assessed H. pylori using a combination of tests. Patients were considered infected with H. pylori only if culture growth was observed, or both histological and CLOtest results were positive. Patients were considered uninfected if the results of at least two tests were negative. Patients with missing test results, results of only a single test, or conflicting test results were not evaluable for H. pylori assessment. RESULTS Of the 2394 endoscopically diagnosed evaluable duodenal ulcer patients, 73% (1737) were confirmed infected with H. pylori at study entry. CONCLUSIONS The results of six carefully designed and controlled studies suggest that an assumed H. pylori infection rate of approximately 95% may overestimate the actual rate of H. pylori infection in duodenal ulcer patients in the United States. Although H. pylori infection is an important factor in the etiology of noniatrogenic duodenal ulcer disease, other factors may predominate in some patients and should not be overlooked in determining an appropriate course of treatment. The empiric use of antibiotic therapy for ulcer patients without confirmation of the presence of H. pylori cannot be recommended.
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Affiliation(s)
- A A Ciociola
- Warner Lambert Company, Morris Plains, New Jersey 07950, USA
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19
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Kubicki JD, Sykes D, Apitz SE. Ab Initio Calculation of Aqueous Aluminum and Aluminum−Carboxylate Complex Energetics and 27Al NMR Chemical Shifts. J Phys Chem A 1999. [DOI: 10.1021/jp983462w] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. D. Kubicki
- Department of Geosciences, The Pennsylvania State University, University Park, Pennsylvania 16802, Department of Chemistry, 1101 University Ave., University of Wisconsin-Madison, Madison, Wisconsin, and Remediation Research Laboratory, SPAWARSYSCEN D361, 53475 Strothe Rd. Rm. 267D, San Diego, California 92152-6325
| | - D. Sykes
- Department of Geosciences, The Pennsylvania State University, University Park, Pennsylvania 16802, Department of Chemistry, 1101 University Ave., University of Wisconsin-Madison, Madison, Wisconsin, and Remediation Research Laboratory, SPAWARSYSCEN D361, 53475 Strothe Rd. Rm. 267D, San Diego, California 92152-6325
| | - S. E. Apitz
- Department of Geosciences, The Pennsylvania State University, University Park, Pennsylvania 16802, Department of Chemistry, 1101 University Ave., University of Wisconsin-Madison, Madison, Wisconsin, and Remediation Research Laboratory, SPAWARSYSCEN D361, 53475 Strothe Rd. Rm. 267D, San Diego, California 92152-6325
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20
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Ambrus JL, Ambrus CM, Dembinsky W, Sykes D, Kulaylat MN, Patel R, Akhter S, Islam A. Thromboembolic disease susceptibility related to red cell membrane fluidity in patients with polycythemia vera and effect of phlebotomies. J Med 1999; 30:299-304. [PMID: 10851563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Thromboembolic disorders are frequent complications in polycythemia vera. In addition to thrombocytosis with hyperaggregability, leukocytosis, and high hematocrit, hyperviscosity syndrome, a new component, is described in the pathophysiology of this phenomenon. There is decreased red cell membrane fluidity with decreased deformability which increases the susceptibility to microvascular occlusion and also increases the chance of disseminated intravascular coagulation (DIC). Periodic phlebotomies improved the hematologic picture in these patients and results in the removal of the "stiff" red cells with an increased production of young red cells, greater membrane fluidity, deformability and less chance of microvascular occlusion.
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Affiliation(s)
- J L Ambrus
- Department of Internal Medicine, State University of New York at Buffalo Medical School, Buffalo General Hospital-Kaleida Health System 14203, USA
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21
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Sykes D, McIntosh WA. Telemedicine, hospital viability, and community embeddedness: a case study. J Healthc Manag 1999; 44:59-71. [PMID: 10345558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Many hospitals today struggle to remain competitive through the adoption of medical technology or expansion of hospital services. This article presents a case study of one hospital's attempt to remain viable through the adoption of telemedicine. Through a 17-year analysis of local hospital-related news reports, it is argued that a hospital's relationship to the local community can affect the success and potential of such innovations. Establishing a pattern of trust and support between the local community and hospital should therefore be an important step in increasing hospital viability.
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Affiliation(s)
- D Sykes
- Texas A&M University, College Station, USA.
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22
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Brown JR, Steinke WE, Zhai J, Sykes D. Aqua-Reslin droplet analysis. J Am Mosq Control Assoc 1998; 14:467-469. [PMID: 10084143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Aerosol droplets were collected, counted, and sorted using a laser system, the Army Insecticide Measuring System, Teflon-coated slides, and magnesium oxide-coated slides. All droplets, for each method and replication, were generated by a London Aire 1820 or a Leco Model 1600. These data indicate that the Army Insecticide Measuring System or Teflon-coated slides are so closely similar to the laser that they could effectively be used in the field without an overwhelming loss in precision.
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Affiliation(s)
- J R Brown
- Navy Disease Vector Ecology and Control Center, Jacksonville, FL 32212-0043, USA
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23
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Mehta N, Hordines J, Sykes D, Doerr RJ, Cohen SA. Low density lipoproteins and Lovastatin modulate the organ-specific transendothelial migration of primary and metastatic human colon adenocarcinoma cell lines in vitro. Clin Exp Metastasis 1998; 16:587-94. [PMID: 9932605 DOI: 10.1023/a:1006548902592] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Tumor cell arrest and tumor migration are two of the critical steps in the metastatic cascade. We hypothesized that these steps may be facilitated by the low density lipoprotein (LDL)-induced activation of microvessel endothelial cells (MVEC). The purpose of our study was to investigate the biological effects of an LDL-enriched milieu and the effects of the anticholesterol drug Lovastatin on metastatic behavior. The SW480 and SW620 are primary and metastatic human colonic adenocarcinoma cell lines derived from the same patient. We investigated the effect of LDL on adhesion and migration of the two tumor cell lines across human brain, lung, liver and dermal endothelial monolayers. Adhesion and migration assays were done before and after pretreatment of the MVEC or tumor cells with LDL (100 microg/ml) for 24 h. Although metastatic SW620 cells were more adherent to MVEC compared with primary SW480 cells, LDL pretreatment of SW480 and SW620 cells did not affect tumor cell adhesion to MVEC. In contrast, tumor cell migration was significantly increased across endothelial monolayers when MVEC were pretreated with LDL. Transendothelial cell migration was not significantly affected by pretreatment of the tumor cells with LDL. Lovastatin is an inhibitor of HMG-CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis. It has been shown to have anti-tumor activity in vitro. We investigated the effect of Lovastatin on tumor cell kinetics and tumor cell migration across MVEC. Growth curves and migration assays were done before and after pretreatment of the tumor cells with Lovastatin (30 microg/ml). Migration assays were also done after treatment of unstimulated or LDL-stimulated MVEC (100 microg/ml) for 24 h with Lovastatin. Lovastatin inhibited the in vitro growth of the metastatic SW620 cell line to a greater extent than the invasive SW480E cell line. On the other hand, pretreatment of tumor cells with Lovastatin (30 microg/ml) did not suppress transendothelial tumor cell migration of tumor cells. Finally, Lovastatin given to mice effectively suppressed the number of MCA-26 tumor colonies in the liver of Balb/c mice compared with untreated mice.
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Affiliation(s)
- N Mehta
- VA Medical Center, Department of Surgery, School of Medicine, State University of New York at Buffalo, 14215, USA
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24
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Abstract
The effect of carrageenans, a family of polysulphated polysaccharides, on the binding of basic fibroblast growth factor (bFGF) to low affinity (heparin-like) receptors and high affinity receptors on baby hamster kidney cells was investigated. kappa-, iota-, and lambda-carrageenans all inhibited binding of bFGF to both types of receptors with iota-carrageenan being the most potent inhibitor (IC50 values of approx. 0.7 and 4 micrograms/mL for inhibition of binding to low and high affinity receptors respectively). Heparin reduced the inhibition of bFGF binding to high affinity receptors caused by iota-carrageenan. Heparin and iota-carrageenan were comparable in their activities at displacing pre-bound bFGF from both low affinity receptors and high affinity receptors. These results indicate that iota-carrageenan binds to the heparin-binding domain on bFGF and that this may be sufficient to reduce the ability of bFGF to bind to high affinity receptors.
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Affiliation(s)
- R Hoffman
- Clinical Oncology and Radiotherapeutics Unit, MRC Centre, Cambridge, U.K
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25
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Mulkerrin E, Brain A, Hampton D, Sykes D, Penney M, Woodhouse K. Plasma Arginine Vasopressin Levels During Atrial Natriuretic Peptide Infusion in the Young and Elderly. Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_2.p14-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Finucane P, Nicklason F, Dewar R, Woodhead JS, MacMahon M, Kelleher BP, Dockrell D, O’Broin SD, Ryder RJW, Walsh JB, Coakley D, Hegarty V, Hassan J, Yanni G, Whelan A, Feighery C, Bresnihan B, Keane J, Chan F, Over J, Finnucane P, Liston R, Clinch D, Scott T, Moloney B, Tiernan E, White S, Murphy K, Henry C, Twomey C, Hyland CM, Gregg ME, Beringer TRO, Henderson SA, Finlay OE, Murphy NM, Boreham CAG, Mollan RAB, Gilmore DH, Browne JP, O’Boyle CA, McGee HM, O’Malley KM, Joyce CRB, Mulkerrin E, Hampton D, Donovan K, Penney M, Sykes D, O’Neill D, Surmon D, Wilcock GK, O’Mahony D, Rowan M, Feely J, Lyons RA, McCarthy R, Murphy S, Rajan L, Fielding JF, Clements L, Cherot E, Greenough WB, West KP. Irish gerontological society. Ir J Med Sci 1992. [DOI: 10.1007/bf02942385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Abstract
The blood pressure in both arms of 103 unselected hemiplegic patients was measured using a random-zero sphygmomanometer. Although for the whole sample the mean blood pressure in the paretic and unaffected arm was similar, a significant difference was found when the patients were subdivided according to the tone of the arm. The blood pressure was higher in paretic arms of patients with a spastic stroke and lower in the affected arm if the tone was flaccid. No other characteristics were associated with significant blood pressure differences, so that the findings appear to be directly related to changes in muscle tone. After a stroke the blood pressure should always be measured in the unaffected arm because changes in tone make measurements unreliable.
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Affiliation(s)
- R Dewar
- University Department of Geriatrics, Cardiff Royal Infirmary, UK
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28
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Abstract
An oral glucose tolerance test (OGTT, 75 g WHO criteria) was applied to healthy elderly subjects (mean age 76 years) within a week of measurement of random blood glucose and glycosylated haemoglobin (HbA1). The 'Corning' method was used to assay HbA1 (established normal range for our laboratory 5-8%). Sixty-five subjects (38 women) of whom 54 were not diabetic on WHO criteria for OGTT participated in the study. Five of the 54 patients with non-diabetic OGTT results had abnormal HbA1 (greater than 8%). These five subjects had no evidence of impaired glucose tolerance. Eleven subjects had diabetic OGTT results of whom only four had raised HbA1 assay results. Seven subjects had normal HbA1 in spite of diabetic OGTT. The mean HbA1 in the group of subjects with normal OGTT (n = 52) was 6.7% (SD 1.05, range 4.6-8.7%). It appears from our study that the normal range of HbA1 in elderly subjects is not markedly different from established normal values. The poor sensitivity (36%) and predictive value (44%) of abnormal HbA1 in detecting diabetes, as shown in our study, would not permit its use for screening purposes nor as a confirmatory test for diabetes in elderly subjects.
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Affiliation(s)
- E C Mulkerrin
- Department of Geriatric Medicine, University Hospital of Wales, Heath Park, Cardiff
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29
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Reif S, Sykes D, Rossi T, Weiser MM. Changes in transcripts of basement components during rat liver development: increase in laminin messenger RNAs in the neonatal period. Hepatology 1992; 15:310-5. [PMID: 1735535 DOI: 10.1002/hep.1840150222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The expression of laminin and type IV collagen messenger RNA in rat liver was investigated in relation to liver development. Levels of messenger RNA for laminin chains A, B1 and B2, and alpha 1 and alpha 2 chains of type IV collagen were studied by Northern-blot and dot-blot analysis. Although the expression of messenger RNAs for laminin B1 and B2 chains was higher in 19-day gestational fetal liver when compared with the adult, the highest level was detected in 15-day newborns. This finding coincides with the final establishment of the mature liver. Laminin A messenger RNA was not detected in the 19-day gestational fetus or in the neonatal period. In contrast, alpha 1-(IV) and alpha 2-(IV) collagen messenger RNAs maintained high levels in the early neonate and then decreased gradually after 15 days. Our findings suggest that during late stages of liver ontogeny the main components of liver basement membrane proteins undergo a significant alteration in their synthesis. The data further suggest that laminin may play a role in the final stages of hepatic differentiation.
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Affiliation(s)
- S Reif
- Department of Pediatrics, University of New York, Buffalo
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30
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Mulkerrin E, Nicklason F, Sykes D, Dewar R, Bayer A, Finucane P. Assessment of Cognitive Impairment in Patients Being Discharged from Geriatric Wards. Age Ageing 1992. [DOI: 10.1093/ageing/21.suppl_1.p15-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Mulkerrin E, Donovan K, Hampton D, Dewar R, Penney M, Sykes D. The Hormonal Response of Elderly Patients with Congestive Cardiac Failure (CCF) to Angiotensin Converting Enzyme (ACE) Inhibition. Age Ageing 1992. [DOI: 10.1093/ageing/21.suppl_1.p16-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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O’Mahony D, Rowan M, Feely J, Walsh JB, Coakley D, Nicklason F, Mulkerrin E, Sykes D, Dewar R, Finucane P, Beringer TRO, O’Mahony P, Matheson R, Webster M, MacMahon M, Lynch M, Nunes D, Weir DG, O’Moore RR, Keane CT, O’Reilly S, Asian S, Duncan D, Dwear R, Nicklasan F, Thomas D, Seymour R, Duggan J, Kilfeather S, O’Malley K, McCormack PME, Lawlor R, Donegal C, O’Neill D, Rice I, Blake P, Donegan CF, Farrell A, Cunnane G, McCarthy N, Watters L. Irish gerontological society. Ir J Med Sci 1992. [DOI: 10.1007/bf02984673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Mulkerrin EC, Hampton D, Penney M, Brain A, Williams J, Sykes D, Woodhouse KW. Renal Effects of Low Dose Atrial Natriuretic Peptide (ANP) Infusion in Young and Elderly Volunteers. Age Ageing 1992. [DOI: 10.1093/ageing/21.suppl_2.p16-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mulkerrin E, Penney MD, Donovan K, Hampton D, Arnold J, Sykes D. Changes in AVP following aggressive diuretic therapy of severe congestive cardiac failure in elderly patients. Postgrad Med J 1991; 67:1085. [PMID: 1800973 PMCID: PMC2399180 DOI: 10.1136/pgmj.67.794.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
A standard Snellen letter chart was used to screen the visual acuities of 202 elderly patients while they attended outpatients clinics. Patients overestimated the adequacy of their vision: only 34 patients reported inadequate vision while 72 had significant measured visual impairment. Of these, 30 patients had refractive errors and 42 primarily non-refractive problems. Thirty patients were examined by an ophthalmologist, of whom 24 had previously undiagnosed conditions. Eighteen patients had treatable conditions, predominantly cataracts and glaucoma. Ten patients with untreatable conditions had the benefit of a definitive diagnosis, most commonly of age-related macular degeneration, and an assessment of eligibility for registration of blindness. The routine assessment of elderly patients should include objective screening of their visual acuity.
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Affiliation(s)
- C A Long
- University Department of Geriatric Medicine, Cardiff Royal Infirmary
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Ip MM, Shea WK, Sykes D, Young DA. The truncated glucocorticoid receptor in the P1798 mouse lymphosarcoma is associated with resistance to glucocorticoid lysis but not to other glucocorticoid-induced functions. Cancer Res 1991; 51:2786-96. [PMID: 1674446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Glucocorticoid receptors in lines of the P1798 mouse lymphosarcoma either sensitive or resistant to glucocorticoid-induced lysis have been characterized and their functional significance determined. The glucocorticoid receptor from the cortisol-sensitive tumor is an Mr approximately 98,000 protein with a Stokes radius of 7.4 nm in the oligomeric, non-DNA-binding state and 5.6 nm in the transformed, DNA-binding state. This receptor binds glucocorticoid and reacts with the BUGR-2 monoclonal antibody. In contrast, two abnormal receptor species were identified in the cortisol-resistant tumor. One is an Mr approximately 98,000 non-steroid-binding but immunologically reactive protein. The other is an Mr approximately 45,000 species which contains both steroid- and DNA-binding sites but exhibits little or no reactivity with BUGR-2, suggesting that its NH2 terminus is truncated in a region within or adjacent to the BUGR epitope. This species had Stokes radii of 5.8 and 3.5 nm in nontransformed and transformed states, respectively. In both tumor lines, glucocorticoids stimulated the activities of glutamine synthetase and 5'-nucleotidase and the synthesis of glucocortin. However, glucocorticoid-induced tumor regression occurred only in the cortisol-sensitive tumor. Additionally, the glucocorticoid inducibility of a specific protein in the sensitive, but not in the resistant, tumor was demonstrated, as well as the presence of a protein specific to the resistant line. Taken together, these results suggest that the truncated glucocorticoid receptor in the P1798 lymphosarcoma is functional, although possibly in a more restricted gene-specific manner, and that the lysis defect, while possibly resulting from a truncated receptor, may also result from the inability of glucocorticoids to induce a critical protein in the pathway of programmed cell death and/or from the presence of a protein which inhibits the lytic response.
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Affiliation(s)
- M M Ip
- Grace Cancer Drug Center, Roswell Park Cancer Institute, Buffalo, New York 14263
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37
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Diggory RT, Wu AV, Sykes D. Detached thyroid nodule. J R Coll Surg Edinb 1991; 36:195-6. [PMID: 1920242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R T Diggory
- Department of Surgery, Walton Hospital, Liverpool, UK
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38
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Gil KM, Ginsberg B, Muir M, Sykes D, Williams DA. Patient-controlled analgesia in postoperative pain: the relation of psychological factors to pain and analgesic use. Clin J Pain 1990; 6:137-42. [PMID: 2135004 DOI: 10.1097/00002508-199006000-00012] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The surgical experience is often characterized by fear, stress, and pain. Whenever an individual has to confront a painful or stressful event such as surgery, the individual's opportunity to control some aspect of the situation may actually influence the degree of pain experienced. Patient-controlled analgesia (PCA) is a relatively new method of analgesic administration that allows the postoperative patient to self-administer analgesic drug. The present study examined the relationship of psychological variables, including anxiety, depression, coping strategies, and social support, to pain and PCA use in a sample of 80 adults who underwent orthopaedic surgeries. Regression analyses controlling for age and type of opioid revealed that the psychological measures were important predictors of pain and PCA use. Patients with higher anxiety levels and less social support had higher postoperative pain and made more frequent PCA demands.
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Affiliation(s)
- K M Gil
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710
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39
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Sykes D, Donovan K, Dewar R, Nicklason F, Mohanaruban K, Thomas D, Fisher D. Measuring blood pressure in the elderly: Authors' reply. West J Med 1990. [DOI: 10.1136/bmj.300.6723.538-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sykes D, Dewar R, Mohanaruban K, Donovan K, Nicklason F, Thomas DM, Fisher D. Measuring blood pressure in the elderly: does atrial fibrillation increase observer variability? BMJ 1990; 300:162-3. [PMID: 2105795 PMCID: PMC1662156 DOI: 10.1136/bmj.300.6718.162] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare the interobserver and intraobserver variability of blood pressure measurements in geriatric patients in atrial fibrillation and in sinus rhythm. DESIGN Prospective assessment of blood pressure measurements carried out in random order in two groups of elderly patients by five doctors unaware of the aims of the study. SETTING Acute assessment wards for geriatric medicine, Cardiff Royal Infirmary. PATIENTS 50 Elderly patients in sinus rhythm and 50 in atrial fibrillation. MAIN OUTCOME MEASURES Interobserver and intraobserver variability of blood pressure measurements in the two groups expressed as the coefficient of variability and compared by the Mann-Whitney U test. RESULTS Interobserver variability was significantly greater in the patients with atrial fibrillation for both systolic and diastolic pressures. Intraobserver variability was significantly greater in the atrial fibrillation group for diastolic pressures but the difference was not significant for systolic pressures. These differences were not related to pulse rate, age, or level of blood pressure. CONCLUSIONS The findings suggest that in the presence of atrial fibrillation physicians' interpretations of Korotkoff sounds are less uniform, which may have important clinical implications. Possibly a standardised methodology may overcome this problem.
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Affiliation(s)
- D Sykes
- University Department of Geriatric Medicine, Cardiff Royal Infirmary
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42
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Steinfort C, Wilson R, Mitchell T, Feldman C, Rutman A, Todd H, Sykes D, Walker J, Saunders K, Andrew PW. Effect of Streptococcus pneumoniae on human respiratory epithelium in vitro. Infect Immun 1989; 57:2006-13. [PMID: 2731981 PMCID: PMC313834 DOI: 10.1128/iai.57.7.2006-2013.1989] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A total of 11 of 15 Streptococcus pneumoniae culture filtrates and all five bacterial autolysates produced by cell death in the stationary phase caused slowed ciliary beating and disruption of the surface integrity of human respiratory epithelium in organ culture. This effect was inhibited by cholesterol and was heat labile and reduced by standing at room temperature but was stable at -40 degrees C. The activity was detected at the late stationary phase of culture and was associated with the presence of hemolytic activity. Gel filtration of a concentrated culture filtrate and autolysate both yielded a single fraction of approximately 50 kilodaltons which slowed ciliary beating and were the only fractions with hemolytic activity. Rabbit antiserum to pneumolysin, a sulfhydryl-activated hemolytic cytotoxin released by S. pneumoniae during autolysis, neutralized the effect of the culture filtrate on respiratory epithelium. Both native and recombinant pneumolysin caused ciliary slowing and epithelial disruption. Electron microscopy showed a toxic effect of pneumolysin on epithelial cells: cytoplasmic blebs, mitochondrial swelling, cellular extrusion, and cell death, but no change in ciliary ultrastructure. Recombinant pneumolysin (10 micrograms/ml) caused ciliary slowing in the absence of changes in cell ultrastructure. Release of pneumolysin in the respiratory tract during infection may perturb host defenses, allowing bacterial proliferation and spread.
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Affiliation(s)
- C Steinfort
- Department of Thoracic Medicine, Brompton Hospital, London, United Kingdom
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43
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Abstract
Three cell lines have been isolated and characterized from the P1798 mouse lymphosarcoma. One line, derived from a glucocorticoid-resistant tumor, was glucocorticoid-resistant in vitro. The other two cell lines, derived from glucocorticoid-sensitive and -resistant parental tumors, respectively, were shown to be glucocorticoid-sensitive in vitro. The glucocorticoid receptor from all three cell lines bound glucocorticoid with similar affinity and capacity. However, based on Sephacryl S-300 gel filtration, the glucocorticoid receptor from the resistant cell line was smaller than that of the two sensitive cell lines. Moreover, the glucocorticoid receptor from the resistant cell line accumulated to a greater extent in the nucleus. This resistant cell line thus resembles the nti variant of the S49 lymphoma cell line. All three cell lines were tumorigenic and metastatic when reimplanted into mice, contained the normal mouse diploid complement of 40 chromosomes and exhibited the same responsiveness to cortisol in vivo as they did in vitro. It is concluded that the ready passage of these cell lines in vitro or in vivo and the presence of the small receptor in the resistant line should make them excellent model systems for the study of glucocorticoid resistance.
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Affiliation(s)
- C W Chi
- Grace Cancer Drug Center, Roswell Park Memorial Institute, New York State Department of Health, Buffalo 14263
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Wilson R, Munro N, Hostie A, Rutman A, Sykes D, Watson D, Shryock T, Taylor G, Cole P. Pseudomonas aeruginosa Produces Low Molecular Weight Molecules that Damage Human Respiratory Epithelium in vitro and Slow Mucociliary Transport in the Guinea Pig Trachea in vivo. Chest 1989. [DOI: 10.1378/chest.95.3_supplement.214s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Steinfort C, Wilson R, Rutman A, Sykes D, Todd H, Walker J, Mitchell T, Saunders K, Andrew P, Boulnois G, Cole P. Pneumolysin Produced by Streptococcus pneumoniae Damages Human Respiratory Epithelium in vitro. Chest 1989. [DOI: 10.1378/chest.95.3_supplement.221s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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46
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Abstract
The case report describes a female of 82 who presented with a very large goitre caused by a solitary thyroid cyst that was successfully treated by aspiration.
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Wilson R, Pitt T, Taylor G, Watson D, MacDermot J, Sykes D, Roberts D, Cole P. Pyocyanin and 1-hydroxyphenazine produced by Pseudomonas aeruginosa inhibit the beating of human respiratory cilia in vitro. J Clin Invest 1987; 79:221-9. [PMID: 3098783 PMCID: PMC424027 DOI: 10.1172/jci112787] [Citation(s) in RCA: 188] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Pseudomonas aeruginosa culture filtrates varied in their ability to slow human ciliary beat frequency (7-71%). This activity did not correlate with known virulence factors. However, a close correlation (r = 0.97) existed between ciliary slowing and pigment content. In a prolonged culture, the increase in activity correlated (r = 0.94) with pigment accumulation. Gel filtration of lyophilized filtrate yielded a single peak of activity corresponding to the pigment fraction. Pyocyanin extracted from an active strain, and 1-hydroxyphenazine were purified by high performance liquid chromatography, and characterized by ultraviolet absorbance spectra and mass spectrometry. Both slowed cilia in a dose-dependent manner, and were synthesized and shown to be indistinguishable from the biological compounds. Pyocyanin caused gradual onset of slowing and ultimate widespread ciliostasis with epithelial disruption. 1-hydroxyphenazine caused rapid onset of ciliary slowing associated with dyskinesia and ciliostasis. Pyocyanin assayed within filtrates accounted for a significant proportion of the bioactivity present.
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Fuller RW, Morris PK, Richmond R, Sykes D, Varndell IM, Kemeny DM, Cole PJ, Dollery CT, MacDermot J. Immunoglobulin E-dependent stimulation of human alveolar macrophages: significance in type 1 hypersensitivity. Clin Exp Immunol 1986; 65:416-26. [PMID: 2947765 PMCID: PMC1542321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Human alveolar macrophages were obtained during diagnostic bronchoalveolar lavage. Cells were cultured, and morphological examination (including electron microscopy) revealed that not more than 5% of the cultured cells were identifiable as cells other than alveolar macrophages. The cells were sensitized with human myeloma immunoglobulin E. and then challenged with anti-immunoglobulin E anti-sera. The experiments employed a highly specific monoclonal antibody and three affinity purified reagents. The formation of immunoglobulin E/anti-immunoglobulin E complexes facilitated release from alveolar macrophages of leukotriene B4, prostaglandin F2 alpha, thromboxane B2 and the lysosomal hydrolase N-acetyl-beta-D-glucosaminidase. There was no release of active oxygen species, with this stimulus, as measured by lucigenin chemiluminescence. Immunoglobulin E receptors were identified histochemically on the surface of human alveolar macrophages, and were visualized as conjugates with colloidal gold by electron microscopy. These results support the view that human alveolar macrophages may contribute to type 1 hypersensitivity reactions in the lung.
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Wilson R, Sykes D, Cole PJ. Pulmonary disease associated with Pseudomonas aeruginosa in cystic fibrosis: current status of the host-bacterium interaction. J Infect Dis 1986; 153:376. [PMID: 3080535 DOI: 10.1093/infdis/153.2.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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50
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Wilson R, Sykes D, Currie D, Cole P. Multiple respiratory tract stenoses associated with mucociliary dysfunction. Lancet 1985; 2:950. [PMID: 2865448 DOI: 10.1016/s0140-6736(85)90883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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