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Hudock S, Hysell M, Luna M, Dixon E, Mangione M, Holsinger H, Zamarripa A, Benner C, Ouellette L, Jones JS. Aural search & rescue: Techniques for ear foreign body removal in the emergency department. Am J Emerg Med 2024; 75:167-168. [PMID: 37940455 DOI: 10.1016/j.ajem.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Affiliation(s)
- S Hudock
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - M Hysell
- Corewell Health Lakeland Emergency Medicine Residency Program, St. Joseph, MI, United States of America
| | - M Luna
- Corewell Health Lakeland Emergency Medicine Residency Program, St. Joseph, MI, United States of America
| | - E Dixon
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - M Mangione
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - H Holsinger
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - A Zamarripa
- Corewell Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - C Benner
- Corewell Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - L Ouellette
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - J S Jones
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America; Corewell Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America.
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2
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Lee FK, Lee JC, Shui B, Reining S, Jibilian M, Small DM, Jones JS, Allan-Rahill NH, Lamont MR, Rizzo MA, Tajada S, Navedo MF, Santana LF, Nishimura N, Kotlikoff MI. Genetically engineered mice for combinatorial cardiovascular optobiology. eLife 2021; 10:67858. [PMID: 34711305 PMCID: PMC8555989 DOI: 10.7554/elife.67858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/13/2021] [Indexed: 01/21/2023] Open
Abstract
Optogenetic effectors and sensors provide a novel real-time window into complex physiological processes, enabling determination of molecular signaling processes within functioning cellular networks. However, the combination of these optical tools in mice is made practical by construction of genetic lines that are optically compatible and genetically tractable. We present a new toolbox of 21 mouse lines with lineage-specific expression of optogenetic effectors and sensors for direct biallelic combination, avoiding the multiallelic requirement of Cre recombinase -mediated DNA recombination, focusing on models relevant for cardiovascular biology. Optogenetic effectors (11 lines) or Ca2+ sensors (10 lines) were selectively expressed in cardiac pacemaker cells, cardiomyocytes, vascular endothelial and smooth muscle cells, alveolar epithelial cells, lymphocytes, glia, and other cell types. Optogenetic effector and sensor function was demonstrated in numerous tissues. Arterial/arteriolar tone was modulated by optical activation of the second messengers InsP3 (optoα1AR) and cAMP (optoß2AR), or Ca2+-permeant membrane channels (CatCh2) in smooth muscle (Acta2) and endothelium (Cdh5). Cardiac activation was separately controlled through activation of nodal/conducting cells or cardiac myocytes. We demonstrate combined effector and sensor function in biallelic mouse crosses: optical cardiac pacing and simultaneous cardiomyocyte Ca2+ imaging in Hcn4BAC-CatCh2/Myh6-GCaMP8 crosses. These experiments highlight the potential of these mice to explore cellular signaling in vivo, in complex tissue networks.
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Affiliation(s)
- Frank K Lee
- Department of Biomedical Sciences, Cornell University, Ithaca, United States
| | - Jane C Lee
- Department of Biomedical Sciences, Cornell University, Ithaca, United States
| | - Bo Shui
- Department of Biomedical Sciences, Cornell University, Ithaca, United States
| | - Shaun Reining
- Department of Biomedical Sciences, Cornell University, Ithaca, United States
| | - Megan Jibilian
- Department of Biomedical Sciences, Cornell University, Ithaca, United States
| | - David M Small
- Department of Biomedical Engineering, Cornell University, Ithaca, United States
| | - Jason S Jones
- Department of Biomedical Engineering, Cornell University, Ithaca, United States
| | | | - Michael Re Lamont
- Department of Biomedical Engineering, Cornell University, Ithaca, United States
| | - Megan A Rizzo
- Department of Physiology, University of Maryland School of Medicine, Baltimore, United States
| | - Sendoa Tajada
- Departments of Physiology and Membrane Biology, University of California, Davis School of Medicine, Davis, United States
| | - Manuel F Navedo
- Department of Pharmacology, University of California, Davis, Davis, United States
| | - Luis Fernando Santana
- Departments of Physiology and Membrane Biology, University of California, Davis School of Medicine, Davis, United States
| | - Nozomi Nishimura
- Department of Biomedical Engineering, Cornell University, Ithaca, United States
| | - Michael I Kotlikoff
- Department of Biomedical Sciences, Cornell University, Ithaca, United States
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3
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Antolick A, Ouellette L, Judge B, Riley B, Jones JS. Accidental Chlorine Gas Exposure in a Pediatric Patient: A Case Report. Clin Pract Cases Emerg Med 2020; 4:205-207. [PMID: 32426673 PMCID: PMC7220003 DOI: 10.5811/cpcem.2020.3.46746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/26/2020] [Accepted: 03/20/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Chlorine gas is a known irritant of the respiratory tract, which may cause damage to various systems depending on time of exposure and concentration of the gas. Current treatments are mainly supportive. While no definitive studies have been completed to date, it has been noted that treatment with a sodium bicarbonate solution via nebulizer may lead to improved outcomes for patients dealing with chlorine gas exposure. Case Report We present a case of a nine-year-old child arriving at the emergency department after exposure to chlorine gas. Complete recovery from his symptoms occurred rapidly with the administration of nebulized sodium bicarbonate. Discussion Inhaled chlorine gas acts as a mucous membrane irritant, with symptoms usually beginning within minutes of exposure. Inhaled nebulized sodium bicarbonate has been suggested as a therapy for chlorine exposure. Although its mechanism of action is not well understood, it is thought that inhaled sodium bicarbonate neutralizes the hydrochloric acid formed when the chlorine gas reacts with the water in the lungs. Conclusion Nebulized sodium bicarbonate solution at a low concentration appeared to rapidly and effectively reverse the symptoms due to chlorine gas inhalation in a young child.
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Affiliation(s)
- Ashley Antolick
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, Michigan
| | - Lindsey Ouellette
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, Michigan
| | - Bryan Judge
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, Michigan
| | - Brad Riley
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, Michigan
| | - JS Jones
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, Michigan
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4
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Tavares EM, Judge BS, Jones JS. Bug off! Severe toxicity following inhalational exposure to N, N-diethyl-meta-toluamide (DEET). Am J Emerg Med 2019; 37:1395.e3-1395.e4. [PMID: 31005398 DOI: 10.1016/j.ajem.2019.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022] Open
Abstract
N, N-diethyl-meta-toluamide (DEET) is an insect repellent currently used by millions of people since 1956. DEET has an excellent safety profile and has remarkable protection against mosquitoes, ticks and various other arthropods. Toxicity is unusual, and is generally associated with incorrect, or overuse of the product. We report a patient with severe toxicity following inhalational exposure to a "bug bomb". containing 98% DEET.
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Affiliation(s)
- Erica M Tavares
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Bryan S Judge
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - J S Jones
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America.
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5
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Jones JS, Small DM, Nishimura N. In Vivo Calcium Imaging of Cardiomyocytes in the Beating Mouse Heart With Multiphoton Microscopy. Front Physiol 2018; 9:969. [PMID: 30108510 PMCID: PMC6079295 DOI: 10.3389/fphys.2018.00969] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/02/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Understanding the microscopic dynamics of the beating heart has been challenging due to the technical nature of imaging with micrometer resolution while the heart moves. The development of multiphoton microscopy has made in vivo, cell-resolved measurements of calcium dynamics and vascular function possible in motionless organs such as the brain. In heart, however, studies of in vivo interactions between cells and the native microenvironment are behind other organ systems. Our goal was to develop methods for intravital imaging of cardiac structural and calcium dynamics with microscopic resolution. Methods: Ventilated mice expressing GCaMP6f, a genetically encoded calcium indicator, received a thoracotomy to provide optical access to the heart. Vasculature was labeled with an injection of dextran-labeled dye. The heart was partially stabilized by a titanium probe with a glass window. Images were acquired at 30 frames per second with spontaneous heartbeat and continuously running, ventilated breathing. The data were reconstructed into three-dimensional volumes showing tissue structure, vasculature, and GCaMP6f signal in cardiomyocytes as a function of both the cardiac and respiratory cycle. Results: We demonstrated the capability to simultaneously measure calcium transients, vessel size, and tissue displacement in three dimensions with micrometer resolution. Reconstruction at various combinations of cardiac and respiratory phase enabled measurement of regional and single-cell cardiomyocyte calcium transients (GCaMP6f fluorescence). GCaMP6f fluorescence transients in individual, aberrantly firing cardiomyocytes were also quantified. Comparisons of calcium dynamics (rise-time and tau) at varying positions within the ventricle wall showed no significant depth dependence. Conclusion: This method enables studies of coupling between contraction and excitation during physiological blood perfusion and breathing at high spatiotemporal resolution. These capabilities could lead to a new understanding of normal and disease function of cardiac cells.
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Affiliation(s)
- Jason S Jones
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
| | - David M Small
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
| | - Nozomi Nishimura
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
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6
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Small DM, Jones JS, Tendler II, Miller PE, Ghetti A, Nishimura N. Label-free imaging of atherosclerotic plaques using third-harmonic generation microscopy. Biomed Opt Express 2018; 9:214-229. [PMID: 29359098 PMCID: PMC5772576 DOI: 10.1364/boe.9.000214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/24/2017] [Accepted: 12/02/2017] [Indexed: 05/18/2023]
Abstract
Multiphoton microscopy using laser sources in the mid-infrared range (MIR, 1,300 nm and 1,700 nm) was used to image atherosclerotic plaques from murine and human samples. Third harmonic generation (THG) from atherosclerotic plaques revealed morphological details of cellular and extracellular lipid deposits. Simultaneous nonlinear optical signals from the same laser source, including second harmonic generation and endogenous fluorescence, resulted in label-free images of various layers within the diseased vessel wall. The THG signal adds an endogenous contrast mechanism with a practical degree of specificity for atherosclerotic plaques that complements current nonlinear optical methods for the investigation of cardiovascular disease. Our use of whole-mount tissue and backward scattered epi-detection suggests THG could potentially be used in the future as a clinical tool.
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Affiliation(s)
- David M. Small
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, 526 N. Campus Rd., Ithaca, NY 14853, USA
- Contributed equally
| | - Jason S. Jones
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, 526 N. Campus Rd., Ithaca, NY 14853, USA
- Contributed equally
| | - Irwin I. Tendler
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, 526 N. Campus Rd., Ithaca, NY 14853, USA
| | - Paul E. Miller
- Anabios Corporation, 3030 Bunker Hill St., San Diego, CA 92109, USA
| | - Andre Ghetti
- Anabios Corporation, 3030 Bunker Hill St., San Diego, CA 92109, USA
| | - Nozomi Nishimura
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, 526 N. Campus Rd., Ithaca, NY 14853, USA
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7
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Abstract
A shortcut review was carried out to establish whether intravenous lidocaine is effective in the management of renal colic. Two studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these studies are tabulated. The clinical bottom line is that intravenous lidocaine may be of some benefit in renal colic. However, there are other maybe more effective drugs available.
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Affiliation(s)
- Duke Keller
- Grand Rapids Medical Education Research Partners/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Jason Seamon
- Grand Rapids Medical Education Research Partners/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - J S Jones
- Grand Rapids Medical Education Research Partners/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
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8
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Tay KJ, Scheltema MJ, Ahmed HU, Barret E, Coleman JA, Dominguez-Escrig J, Ghai S, Huang J, Jones JS, Klotz LH, Robertson CN, Sanchez-Salas R, Scionti S, Sivaraman A, de la Rosette J, Polascik TJ. Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project. Prostate Cancer Prostatic Dis 2017; 20:294-299. [PMID: 28349978 DOI: 10.1038/pcan.2017.8] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/14/2017] [Accepted: 01/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Whole-gland extirpation or irradiation is considered the gold standard for curative oncological treatment for localized prostate cancer, but is often associated with sexual and urinary impairment that adversely affects quality of life. This has led to increased interest in developing therapies with effective cancer control but less morbidity. We aimed to provide details of physician consensus on patient selection for prostate focal therapy (FT) in the era of contemporary prostate cancer management. METHODS We undertook a four-stage Delphi consensus project among a panel of 47 international experts in prostate FT. Data on three main domains (role of biopsy/imaging, disease and patient factors) were collected in three iterative rounds of online questionnaires and feedback. Consensus was defined as agreement in ⩾80% of physicians. Finally, an in-person meeting was attended by a core group of 16 experts to review the data and formulate the consensus statement. RESULTS Consensus was obtained in 16 of 18 subdomains. Multiparametric magnetic resonance imaging (mpMRI) is a standard imaging tool for patient selection for FT. In the presence of an mpMRI-suspicious lesion, histological confirmation is necessary prior to FT. In addition, systematic biopsy remains necessary to assess mpMRI-negative areas. However, adequate criteria for systematic biopsy remains indeterminate. FT can be recommended in D'Amico low-/intermediate-risk cancer including Gleason 4+3. Gleason 3+4 cancer, where localized, discrete and of favorable size represents the ideal case for FT. Tumor foci <1.5 ml on mpMRI or <20% of the prostate are suitable for FT, or up to 3 ml or 25% if localized to one hemi-gland. Gleason 3+3 at one core 1mm is acceptable in the untreated area. Preservation of sexual function is an important goal, but lack of erectile function should not exclude a patient from FT. CONCLUSIONS This consensus provides a contemporary insight into expert opinion of patient selection for FT of clinically localized prostate cancer.
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Affiliation(s)
- K J Tay
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - M J Scheltema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College of London, London, UK
| | - E Barret
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - J A Coleman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Dominguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - S Ghai
- University of Toronto, Toronto, ON, Canada
| | - J Huang
- Department of Pathology, Duke University, Durham, NC, USA
| | - J S Jones
- Cleveland Clinic, Cleveland, OH, USA
| | - L H Klotz
- Sunnybrook Medical Center, Toronto, ON, Canada
| | - C N Robertson
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - R Sanchez-Salas
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - S Scionti
- Saratosa Prostate Cancer Center, Sarasota, FL, USA
| | - A Sivaraman
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - J de la Rosette
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - T J Polascik
- Duke Cancer Institute, Duke University, Durham, NC, USA
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9
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Postema AW, De Reijke TM, Ukimura O, Van den Bos W, Azzouzi AR, Barret E, Baumunk D, Blana A, Bossi A, Brausi M, Coleman JA, Crouzet S, Dominguez-Escrig J, Eggener S, Ganzer R, Ghai S, Gill IS, Gupta RT, Henkel TO, Hohenfellner M, Jones JS, Kahmann F, Kastner C, Köhrmann KU, Kovacs G, Miano R, van Moorselaar RJ, Mottet N, Osorio L, Pieters BR, Polascik TJ, Rastinehad AR, Salomon G, Sanchez-Salas R, Schostak M, Sentker L, Tay KJ, Varkarakis IM, Villers A, Walz J, De la Rosette JJ. Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project. World J Urol 2016; 34:1373-82. [PMID: 26892160 PMCID: PMC5026990 DOI: 10.1007/s00345-016-1782-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). METHODS A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. RESULTS Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. CONCLUSION Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.
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Affiliation(s)
- A W Postema
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands.
| | - T M De Reijke
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - O Ukimura
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - W Van den Bos
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - A R Azzouzi
- Department of Urology, Angers University Hospital, Angers, France
| | - E Barret
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - D Baumunk
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - A Blana
- Department of Urology, Fuerth Hospital, Fuerth, Germany
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Brausi
- Department of Urology, Ospedale Civile Ramazzini, Carpi, Italy
| | - J A Coleman
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - S Crouzet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - J Dominguez-Escrig
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - S Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - R Ganzer
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - S Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - I S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R T Gupta
- Departments of Radiology, Duke University Medical Center, Durham, NC, USA
| | - T O Henkel
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - M Hohenfellner
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - J S Jones
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cancer Directorate, Cambridge University Hospitals Trust, Cambridge, UK
| | - K U Köhrmann
- Department of Urology, Theresien Krankenhaus Mannheim, Mannheim, Germany
| | - G Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck, Lübeck, Germany
| | - R Miano
- Division of Urology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - R J van Moorselaar
- Department of Urology, Free University Medical Centre, Amsterdam, The Netherlands
| | - N Mottet
- Department of Urology, University Hospital St Etienne, Saint-Étienne, France
| | - L Osorio
- Department of Urology, Porto Hospital Centre, Porto, Portugal
| | - B R Pieters
- Departments of Radiation Oncology, AMC University Hospital, Amsterdam, The Netherlands
| | - T J Polascik
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A R Rastinehad
- Department of Urology, Hofstra North Shore-Lij, Hofstra University, Hempstead, NY, USA
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - R Sanchez-Salas
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - M Schostak
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - L Sentker
- Urologische Gemeinschaftspraxis, Sinsheim, Germany
| | - K J Tay
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - I M Varkarakis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - J J De la Rosette
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
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10
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Garthe C, Ouellette L, Seamon JP, Jones JS. RETRACTED: The Virtual Cutting Edge: Adolescent Self-injury and YouTube. Ann Emerg Med 2015; 66:S145. [PMID: 27989308 DOI: 10.1016/j.annemergmed.2015.07.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief and Authors. We wish to retract the abstract "The Virtual Cutting Edge: Adolescent Self-injury and YouTube," published in the October 2015 issue of Annals. The abstract excessively borrowed from the text and methodology of a previous study published elsewhere.1 All authors recognize the seriousness of this issue and apologize to the editors and readers of Annals. Jeffrey S. Jones, MD Chad Garthe, MD Lindsey Ouellette, MS Jason Seamon, DO Department of Emergency Medicine MSU College of Human Medicine Grand Rapids, MI 1. Lewis SP, Heath NL, St. Denis JM, et al. The scope of nonsuicidal self-injury on YouTube. Pediatrics. 2011;1127:e552-e557.
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Affiliation(s)
- C Garthe
- College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - L Ouellette
- College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - J P Seamon
- College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - J S Jones
- College of Human Medicine, Michigan State University, Grand Rapids, MI
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11
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Huland DM, Charan K, Ouzounov DG, Jones JS, Nishimura N, Xu C. Three-photon excited fluorescence imaging of unstained tissue using a GRIN lens endoscope. Biomed Opt Express 2013; 4:652-8. [PMID: 23667782 PMCID: PMC3646593 DOI: 10.1364/boe.4.000652] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/07/2013] [Accepted: 03/15/2013] [Indexed: 05/18/2023]
Abstract
We present a compact and portable three-photon gradient index (GRIN) lens endoscope system suitable for imaging of unstained tissues, potentially deep within the body, using a GRIN lens system of 1 mm diameter and 8 cm length. The lateral and axial resolution in water is 1.0 μm and 9.5 μm, respectively. The ~200 μm diameter field of view is imaged at 2 frames/s using a fiber-based excitation source at 1040 nm. Ex vivo imaging is demonstrated with unstained mouse lung at 5.9 mW average power. These results demonstrate the feasibility of three-photon GRIN lens endoscopy for optical biopsy.
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Affiliation(s)
- David M. Huland
- School of Applied and Engineering Physics, Cornell University, 146 Clark Hall, Ithaca, NY 14853, USA
- These authors contributed equally to this work
| | - Kriti Charan
- School of Applied and Engineering Physics, Cornell University, 146 Clark Hall, Ithaca, NY 14853, USA
- These authors contributed equally to this work
| | - Dimitre G. Ouzounov
- School of Applied and Engineering Physics, Cornell University, 146 Clark Hall, Ithaca, NY 14853, USA
| | - Jason S. Jones
- Department of Biomedical Engineering, Cornell University, B57 Weill Hall, Ithaca, NY 14853, USA
| | - Nozomi Nishimura
- Department of Biomedical Engineering, Cornell University, B57 Weill Hall, Ithaca, NY 14853, USA
| | - Chris Xu
- School of Applied and Engineering Physics, Cornell University, 146 Clark Hall, Ithaca, NY 14853, USA
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12
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Winters SA, Wolf KH, Kettinger SA, Seif EK, Jones JS, Bacon-Baguley T. Assessment of risk factors for post-rewarming "rebound hyperthermia" in cardiac arrest patients undergoing therapeutic hypothermia. Resuscitation 2013; 84:1245-9. [PMID: 23567472 DOI: 10.1016/j.resuscitation.2013.03.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 03/21/2013] [Accepted: 03/22/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The outcomes associated with therapeutic hypothermia (TH) after cardiac arrest, while overwhelmingly positive, may be associated with adverse events. The incidence of post-rewarming rebound hyperthermia (RH) has been relatively unstudied and may worsen survival and neurologic outcome. The purpose of this study was to determine the incidence and risk factors associated with RH as well as its relationship to mortality, neurologic morbidity, and hospital length of stay (LOS). METHODS A retrospective, observational study was performed of adult patients who underwent therapeutic hypothermia after an out-of-hospital cardiac arrest. Data describing 17 potential risk factors for RH were collected. The primary outcome was the incidence of RH while the secondary outcomes were mortality, discharge neurologic status, and LOS. RESULTS 141 patients were included. All 17 risk factors for RH were analyzed and no potential risk factors were found to be significant at a univariate level. 40.4% of patients without RH experienced any cause of death during the initial hospitalization compared to 64.3% patients who experienced RH (OR: 2.66; 95% CI: 1.26-5.61; p=0.011). The presence of RH is not associated with an increase in LOS (10.67 days vs. 9.45 days; absolute risk increase=-1.21 days, 95% CI: -1.84 to 4.27; p=0.434). RH is associated with increased neurologic morbidity (p=0.011). CONCLUSIONS While no potential risk factors for RH were identified, RH is a marker for increased mortality and worsened neurologic morbidity in cardiac arrest patients who have underwent TH.
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Affiliation(s)
- S A Winters
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
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13
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Bortsov AV, Platts-Mills TF, Peak DA, Jones JS, Swor RA, Domeier RM, Lee DC, Rathlev NK, Hendry PL, Fillingim RB, McLean SA. Pain distribution and predictors of widespread pain in the immediate aftermath of motor vehicle collision. Eur J Pain 2013; 17:1243-51. [PMID: 23335385 DOI: 10.1002/j.1532-2149.2013.00285.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Musculoskeletal pain is common after motor vehicle collision (MVC). The study objective was to evaluate distribution of pain and predictors of widespread musculoskeletal pain in the early aftermath (within 48 h) of collision. METHODS European American adults aged 18-65 years presenting to the emergency department (ED) after collision who were discharged to home after evaluation were eligible. Evaluation included an assessment of reported pre-collision psychological characteristics, crash characteristics, current pain severity and location, and current psychological symptoms. Adjusted risk ratios were estimated using generalized linear models. RESULTS Among 890 participants included in the study, 589/890 (66%) had pain in three or more regions, and 192/890 (22%) had widespread musculoskeletal pain (pain in seven or more regions). In adjusted analyses, the presence of widespread pain was strongly associated with depressive and somatic symptoms prior to collision, pain catastrophizing, and acute psychological symptoms, and was not associated with most collision characteristics (road speed limit, extent of vehicle damage, collision type, driver vs. passenger, airbag deployment). The reported number of body regions that struck an object during the collision was associated with both reported pre-collision depressive symptoms and with widespread pain. CONCLUSION More than one in five individuals presenting to the ED in the hours after MVC have widespread pain. Widespread pain is strongly associated with patient characteristics known to be modulated by supraspinal mechanisms, suggesting that stress-induced hyperalgesia may influence acute widespread pain after collision.
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Affiliation(s)
- A V Bortsov
- Department of Anesthesiology, University of North Carolina, Chapel Hill, USA
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14
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Abstract
Enzyme polymorphisms in the land snail Cepaea nemoralis in the central Pyrenees show concordant geographic patterns of strong differentiation that are not correlated with the distributions of characters of shell color and banding or with the major pattern of variation in climate and vegetation type. Three regions of relative genetic uniformity separated by steep clines in allele frequencies are designated as "molecular area effects." A model of allopatric differentiation of populations in temporary geographic isolation during the last period of Pleistocene glaciation, followed by invasion of the Pyrenees and hybridization in secondary contact, is proposed to account for the present-day pattern of genetic differentiation. The genetic structure of the Pyrenean populations of C. nemoralis is not interpretable in terms of stasipatric or parapatric models of speciation.
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Affiliation(s)
- H Ochman
- Department of Biology, University of Rochester, Rochester, New York 14627
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15
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Nguyen CT, Gao T, Hernandez AV, Jones JS. Can residents perform transrectal ultrasound-guided prostate biopsy with patient comfort comparable to biopsy performed by attending staff urologists? Prostate Cancer Prostatic Dis 2009; 13:52-7. [PMID: 19770843 DOI: 10.1038/pcan.2009.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transrectal ultrasound (TRUS)-guided prostate biopsy is a critical diagnostic tool in urology. Residents require adequate training but resident education could have a deleterious effect on patient comfort and morbidity. We compared pain associated with prostate biopsy when performed by staff versus resident urologists in order to determine the impact of resident training. Male patients scheduled to undergo prostate biopsy were assigned to either a staff urologist or a resident as the primary surgeon. All residents were directly assisted by the staff surgeon. The patients were given a visual analogue scale (VAS; 0-100 mm) and were asked to assess the pain associated with each component of prostate biopsy, including probe insertion, anesthetic injection and the biopsies themselves. The mean VAS scores for probe insertion, anesthetic injection and biopsies were 31.0, 30.4 and 30.1, respectively, for patients in the staff cohort and 37.1, 28.9 and 33.6, respectively, for those in the resident cohort. There was a statistically significant difference between staff and resident VAS scores, marked by a higher odds of greater pain with ultrasound probe placement (odds ratio (OR)=1.48, P=0.012) and the biopsies themselves (OR=1.52, P=0.01) in the resident cohort. TRUS biopsy can be performed by adequately trained and supervised resident urologists of all levels, but there is the potential for increased patient pain, particularly with ultrasonic probe insertion and obtaining core biopsies. However, the absolute magnitude of the differences in pain scores between residents and staff was small and may not be clinically meaningful. Such data indicate that urological resident training can be accomplished without compromising patient care and comfort.
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Affiliation(s)
- C T Nguyen
- Department of Regional Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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16
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Morrison JC, Roberts WE, Jones JS, Istwan N, Rhea D, Stanziano G. Frequency of nursing, physician and hospital interventions in women at risk for preterm delivery. J Matern Fetal Neonatal Med 2009. [DOI: 10.1080/jmf.16.2.102.105] [Citation(s) in RCA: 5] [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] [Indexed: 10/20/2022]
Affiliation(s)
- JC Morrison
- Department of Obstetrics and Gynecology University of Mississippi Medical Center Jackson Mississippi USA
| | - WE Roberts
- Department of Obstetrics and Gynecology University of Mississippi Medical Center Jackson Mississippi USA
| | - JS Jones
- Baylor University Medical Center Dallas Texas USA
| | - N Istwan
- Matria Healthcare, Inc Marietta Georgia USA
| | - D Rhea
- Matria Healthcare, Inc Marietta Georgia USA
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17
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Lee UJ, Jones JS. Incidence of prostate cancer in male breast cancer patients: a risk factor for prostate cancer screening. Prostate Cancer Prostatic Dis 2008; 12:52-6. [PMID: 18504455 DOI: 10.1038/pcan.2008.26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Synchronous or metachronous occurrences of both prostate cancer and male breast cancer are rarely reported, but provide insight into their hormonal and genetic biology. We sought to determine the incidence of prostate cancer in male breast cancer patients at our institution, and to examine estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu receptor (HR) status in these patients. A retrospective review was conducted of male breast cancer patients from 1990 to 2006. Histopathologic characteristics and hormone receptor expression was obtained. In 69 patients with male breast cancer, 12 (17%) also had a diagnosis of prostate cancer. Nine had ER-positive status and three were unreported. PR status was positive in 5, whereas 3 had PR-negative status. HR status was positive in 1, whereas 5 had HR-negative status. Male breast cancer patients in this cohort have an incidence of prostate cancer higher than would be predicted in the general population; this risk factor has implications for careful prostate cancer screening.
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Affiliation(s)
- U J Lee
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH 44195, USA
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18
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Patel AR, Jones JS, Zhou M, Schoenfield L, Magi-Galluzzi C. Parasagittal biopsies are more important as part of an initial biopsy strategy than as part of a repeat biopsy strategy: observations from a unique population. Prostate Cancer Prostatic Dis 2007; 10:352-5. [PMID: 17420763 DOI: 10.1038/sj.pcan.4500966] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Comparing the yield of parasagittal biopsies during initial saturation biopsy to the yield during repeat saturation biopsy for detection of prostate cancer. Office-based saturation biopsy (24 cores) with periprostatic lidocaine block was performed in 139 consecutive men who had never previously undergone prostate biopsy. Indication for biopsy was elevated prostate-specific antigen >2.5 ng/dl. Biopsy specimens were obtained and marked by location for histological examination. Subanalysis of patients from this unique study was performed to compare the location of saturation biopsy cancer detection in these patients to a cohort of 100 patients who had previously undergone biopsy with nonmalignant findings. In the initial biopsy group, cancer was detected in 62/139 patients (44.6%). Breakdown of cancer location demonstrated unique parasagittal cancers in 9/62 patients (14.5%). Laterally base cancer was found exclusively in 22/62 patients (35.5%). For the repeat biopsy population, cancer was found in 25 patients (25%); no patients (0%) had exclusive parasagittal cancer. To our knowledge, this is the first study to demonstrate a difference in the location of positive cores between initial and repeat biopsy status. The exclusive parasagittal cancer detection rate decreases significantly in the repeat biopsy population when using the same biopsy method. Our findings support including traditional template parasagittal sampling of the prostate on first-time biopsy in addition to lateral cores typical of extended field biopsies for a total of 10-12 cores. However, parasagittal sampling adds negligible additional information in repeat biopsy; thus we recommend obtaining primarily laterally based cores for repeat biopsy.
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Affiliation(s)
- A R Patel
- Cleveland Clinic, Department of Anatomic Pathology, The Glickman Urological Institute, Cleveland, OH, USA
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19
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Perry MC, Morrissey MC, Jones JS, Paton B, McAuliffe TB, King JB, Thomas P. Number of Repetitions to Maximum in Hop Tests in Patients with Anterior Cruciate Ligament Injury. Int J Sports Med 2005; 26:688-92. [PMID: 16158376 DOI: 10.1055/s-2004-830494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/25/2022]
Abstract
The unilateral horizontal, triple cross-over and vertical hops are commonly used as outcome measures after knee injury but there is little knowledge of the number of repetitions needed to reach maximum performance. Seventy subjects who had either an anterior cruciate ligament deficient or reconstructed knee participated in this study. Unilateral vertical, horizontal, and triple cross-over hop testing was applied to each leg until two consecutive decrements in performance occurred. The number of repetitions to reach maximum during these tests were calculated. Fifteen repetitions of the horizontal and vertical hops, and 10 repetitions of the triple-crossover hop enable distances to be achieved that are acceptably close to maximal levels in these knee-injured patients. In order to increase the likelihood of finding a patient's maximum hop performance after knee injury, more repetitions are suggested than has been reported in the literature.
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Affiliation(s)
- M C Perry
- Division of Applied Biomedical Research, GKT School of Biomedical Sciences, King's College London, Shepherd's House, Guy's Campus, London, UK
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20
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Morrison JC, Roberts WE, Jones JS, Istwan N, Rhea D, Stanziano G. Frequency of nursing, physician and hospital interventions in women at risk for preterm delivery. J Matern Fetal Neonatal Med 2004; 16:102-5. [PMID: 15512719 DOI: 10.1080/14767050400005731] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the frequency of nursing intervention, physician treatment and hospital evaluation for women receiving outpatient management services for preterm labor. METHODS Outpatient services included: patient education; daily and as-needed nursing assessment of monitored uterine activity (MUA) and patient symptoms; treatment compliance; and physician notification for values exceeding established limits. We analyzed service data from women with singleton gestations at 20.0-34.9 weeks. RESULTS Overall, 307 249 days of data from 10 660 women were reviewed, and 634 983 hours of MUA was assessed. On 53 665 (17.5%) of monitored days, patients exhibited increased MUA and/or symptoms of preterm labor with nursing intervention and reassessment. Physician notification/intervention was required 7316 (13.6%) times, and hospital admission was needed for 3163 (43.2%) of these patients. In the hospital 1400 (44.3%) patients received tocolysis. The mean ( +/- standard deviation) length of hospital stay was 3.2 +/- 7.2 days, and 428 (13.5%) of women remained hospitalized until delivery, with 324 (10.2%) delivering within 48 h. CONCLUSION In this population of women receiving outpatient preterm-labor management services, 95.1% of excessive MUA or patient-reported symptoms of preterm labor were managed on an outpatient basis. Outpatient management allowed for appropriate identification and triage of women requiring hospital admission.
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Affiliation(s)
- J C Morrison
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
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21
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Abstract
OBJECTIVE To examine the effectiveness of the longer acting agent bupivacaine in providing periprostatic anaesthesia during transrectal ultrasonography (TRUS)-guided biopsy, as the periprostatic injection of lidocaine has been shown to significantly alleviate the pain of this procedure. PATIENTS AND METHODS Seventy-five patients were randomized to receive a periprostatic injection with either bupivacaine, a lidocaine/bupivacaine (1/1) combination, or no local anaesthesia. Immediately before biopsy 5 mL of the anaesthetic was injected under TRUS guidance into the periprostatic nerves bilaterally. After taking a 10-core biopsy the patients were given a visual analogue scale (VAS; 0-10) to assess their pain during the procedure. RESULTS The mean VAS scores were 2.04 in the bupivacaine group and 4.46 in the control (no local anaesthetic) group (P < 0.001). CONCLUSIONS Bupivicaine provides significant, immediate periprostatic anaesthesia for TRUS biopsy.
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Affiliation(s)
- J C Rabets
- Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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22
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Jones JS. Almost like a whale: rewriting the origin of species. Trans Med Soc Lond 2003; 117:25-8. [PMID: 14509210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Jones JS, Ulchaker JC, Nelson D, Kursh ED, Kitay R, Angie S, Horvat M, Klein EA, Zippe CD. Periprostatic local anesthesia eliminates pain of office-based transrectal prostate biopsy. Prostate Cancer Prostatic Dis 2003; 6:53-5. [PMID: 12664066 DOI: 10.1038/sj.pcan.4500630] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2002] [Indexed: 11/08/2022]
Abstract
Up to 96% of patient who undergo prostate biopsy report pain. We performed periprostatic local anesthesia injection in an effort to improve patient acceptance of prostate biopsy. Sixty patients were randomized to receive either local injection of lidocaine in the periprostatic nerves or no anesthetic. Lidocaine was injected through a 7-inch spinal needle placed through a transrectal ultrasound biopsy guide. Ten-core biopsies were immediately performed. Following biopsy, all patients gave a Visual Analog Scale (VAS) assessment of their pain experienced during biopsy.A majority of patients reported Visual Analog Scale (VAS) scores in the moderate (28.6%) or severe (28.6%) ranges unless local anesthesia was given. Only one of 27 patients (3.7%) receiving local anesthetic reported moderate pain, and none reported severe pain. Mean VAS pain scores were 1.4 in the anesthetic group and 4.5 in the control group (P<0.0001). No difficulty was encountered from scarring in the five patients who underwent nerve spring radical retropubic prostatectomy following local anesthetic injection. Periprostatic injection of local anesthetic essentially eliminates pain from prostate biopsy. Nerve-sparing radical retropubic prostatectomy is not more difficult as a result.
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Affiliation(s)
- J S Jones
- Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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24
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Abstract
The normal structure and function of the pleura are discussed here in addition to how physiological abnormalities and various pathological processes can upset the finely balanced situation between the visceral and parietal pleural surfaces, leading to effusion formation, and/or adhesions. The various inflammatory and reactive processes that affect the pleura, together with primary and secondary tumor formations are described. Particular emphasis is placed on those conditions of the pleura that are associated with asbestos exposure because this group of diseases will increase over the next few decades due to the large number of workers who have been exposed to asbestos. They will therefore be of increasing importance to the clinician, radiologist, and pathologist in future years.
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Affiliation(s)
- J S Jones
- Department of Pathology, City Hospital, Nottingham, NG5 1PB, United Kingdom
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25
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Abstract
The measurement of insulin-like growth factor I (IGF-I) from extracted whole dried blood spots on filter paper is a simple method allowing sample collection to be carried out by the patient at home. One drop of blood is applied to a filter card, air dried and posted to the laboratory. The IGF-I is dissociated from its binding protein by an acidification and neutralization procedure, and IGF-I is then measured by an enzyme-linked immunosorbent assay. Results from the analysis of IGF-I using blood spots on filter paper compared favourably with those from conventional methods, thus showing it to be an ideal and cost-effective technique for the measurement of IGF-I in both adults and children.
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Affiliation(s)
- J S Jones
- Diagnostic Systems Laboratories, Trident Business Centre, Bickersteth Road, London, UK.
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26
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Abstract
STATEMENT OF PROBLEM Randomized controlled trials (RCTs) have become the gold standard for evaluating the effectiveness of treatment interventions. If not properly controlled, bias in the design of trial methodology can affect the validity of the study results. PURPOSE The purpose of this investigation was to assess the methodological quality of RCTs published in 3 prosthodontic journals over a 10-year period. MATERIAL AND METHODS Issues of The International Journal of Prosthodontics, The Journal of Prosthetic Dentistry, and The Journal of Prosthodontics published between 1988 and 1997 were searched manually to identify RCTs. Specific inclusion and exclusion criteria were established to identify articles about studies that qualified as RCTs. Two independent reviewers evaluated all qualified RCTs on the basis of how potential sources of bias in the trial methodology were controlled. Three areas-control of bias at entry, control of bias in assessment of outcome, and control of bias after entry-were evaluated with a scheme developed through the Cochrane Collaboration. A score of 1 or 0 was assigned for each of the 3 potential sources of bias, with the maximum quality score for an RCT being 3 (good bias control) and the minimum 0 (poor control). Frequencies were calculated for each dimension of trial methodology and overall quality scores of the RCTs. RESULTS Sixty-two RCTs were identified from 3631 articles screened. The method of randomization was explicit in only 47% of the RCTs. Forty percent of RCTs incorporated blinding in the assessment of outcome, and 76% accounted for all subjects at the end of the study. Overall quality scores revealed that only 16% of RCTs attempted to control bias in all 3 areas examined. Forty percent were deficient in 1 area, 34% were deficient in 2 areas, and 10% were deficient in all areas examined. CONCLUSION The quality of RCTs published in prosthodontic journals may be improved by minimizing potential sources of bias and adequately reporting trial methodology.
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Affiliation(s)
- H B Dumbrigue
- Baylor College of Dentistry, Texas A & M University Health Science Center, Dallas 75246, USA.
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27
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Abstract
OBJECTIVE To examine effectiveness of immunization recall in an urban pediatric teaching clinic and to identify barriers to recall effectiveness. DESIGN Randomized, controlled trial. Children aged 5 to 17 months who were not up to date (UTD) with recommended immunizations were identified and assigned to intervention (n = 294) or control groups (n = 309). The intervention consisted of a mailed postcard and up to 4 telephone calls. Two months after intervention, UTD status, visit, and probable missed opportunity rates were assessed. RESULTS Of the intervention group, 30% could not be reached. In 12-month-old children in the intervention group compared with those in the control group, there was a trend toward higher UTD rates (51% vs 39%, P =.07) and a higher proportion of UTD children receiving immunizations as opposed to getting more complete documentation (25% vs 10%, P =.005). Similar differences between intervention and control children were not seen in the 7-month and 19-month age categories. More children in the intervention group had a health maintenance visit (17% vs 11%, P =.03). Of children in the intervention group who were seen when not UTD, 17 of 24 (71%) of those seen for an illness visit and 5 of 24 (21%) of those seen for health maintenance probably had missed opportunities to be immunized. CONCLUSIONS Recall efforts were partially successful but were undermined by inability to reach the clinic population, poor documentation of immunizations, and missed opportunities.
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Affiliation(s)
- A Kempe
- The Children's Hospital, Denver, CO 80218, USA
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Jones JS, Dieterich DT. Treatment of hepatitis C virus and HIV coinfection: the road less traveled. AIDS Read 2001; 11:505-10; quiz 529-30. [PMID: 11708083] [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: 02/22/2023]
Abstract
The use of HAART for HIV infection has significantly reduced morbidity and mortality secondary to AIDS-related opportunistic infections. In hepatitis C virus (HCV)-HIV-coinfected patients, progression to AIDS, cirrhosis, and liver failure from HCV infection has become an important issue. Liver disease caused by chronic HCV infection has become the second leading cause of death in some HIV-infected populations. HIV infection is not a contraindication to HCV infection therapy. Several clinical studies have borne out that HCV infection can be safely and successfully treated in HIV-HCV-coinfected patients. These patients should be evaluated and offered anti-HCV treatment as clinically indicated.
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Affiliation(s)
- J S Jones
- Cabrini Medical Center, New York, USA
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30
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Abstract
Redox cycling of catecholestrogen metabolites between quinone and catechol forms is a mechanism of generating potentially mutagenic oxygen radicals in estrogen-induced carcinogenesis. Consistent with this concept, multiple forms of oxygen radical-generated DNA damage are induced by estrogen in cell-free systems, in cells in culture and in rodents prone to estrogen-induced cancer. Metal ions, specifically iron, are necessary for the production of hydroxy radicals. Iron has not received much attention in discussions of estrogen-induced carcinogenesis and human hormone-associated cancer, and is the focus of this review. An elevated dietary iron intake enhances the incidence of carcinogen-induced mammary cancer in rats and estrogen-induced kidney tumors in Syrian hamsters. Estrogen administration increases iron accumulation in hamsters and facilitates iron uptake by cells in culture. In humans, elevated body iron storage has been shown to increase the risk of several cancers including breast cancer. A role of iron in hormone-associated cancer in humans offers attractive routes for cancer prevention by regulating metal ion metabolism and interfering with iron accumulation in tissues.
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Affiliation(s)
- J G Liehr
- Stehlin Foundation for Cancer Research, 1918 Chenevert, Houston, TX 77003, USA.
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31
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Abstract
We describe neonatal hepatitis B virus (HBV) vaccine policies in Colorado before and after thimerosal recommendations, plans for use of thimerosal-free HBV vaccine, and nurses' awareness of high-risk criteria for HBV vaccination. The results suggest that fewer neonates are receiving HBV vaccine at birth hospitals.
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Affiliation(s)
- R M Brayden
- Colorado Rural Immunization Services Project and the Department of Pediatrics, University of Colorado School of Medicine, Denver, USA
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32
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Abstract
OBJECTIVE To identify barriers to enrollment into Colorado's Child Health Insurance Plan (CHP+) for non-Hispanic (NH), Hispanic (H), and uninsured families. DESIGN Telephone survey of 1) random samples of families who requested an application but did not complete it (N = 273 NH, N = 159 H) and 2) families with uninsured children identified by random-digit-dial statewide surveys (N = 165). RESULTS Major reasons for not enrolling included 1) got other insurance (NH 16.5%; H 27.2% P <.01), 2) thought household income was too high to qualify (NH 21.0%; H 11.9% P =.01), and 3) paperwork (NH 13.4%; H 14.7%, P = NS). Of those who thought their income was too high (N = 76, 17.6%), 58.5% appeared eligible based on reported income. Of uninsured families, only 41.7% had heard of CHP+. Of those who had never applied, major remediable reasons included not knowing enough about the program (20.9%) and thinking household income was too high (9.3%). CONCLUSIONS Effective marketing and education to increase awareness of CHP+ and ensure understanding of eligibility are critical to the success of the program.
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Affiliation(s)
- A Kempe
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA.
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Abstract
Although rare, a congenital direct fistula connection between the proximal right pulmonary artery and the left atrium can present as cyanosis in the newborn. We report the first case in which catheter-based coil closure of such a fistula in a neonate resulted in rapid clinical improvement, obviating the need for surgical repair.
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Affiliation(s)
- M C Slack
- Center for Heart and Kidney Disease, Children's National Medical Center and George Washington University, Washington, DC 20010, USA
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34
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Abstract
Isolated impalement injury to the urinary bladder is a rare occurrence. We present a case in which the delay in the diagnosis reveals the potential pitfalls in the management of such injuries.
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Affiliation(s)
- J S Jones
- Department of Urologic Surgery, St. John's Regional Medical Center, Springfield, Missouri, USA
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35
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Ogueh O, Miell JP, Jones JC, Jones JS, Alaghband-Zadeh J, Johnson MR. Antenatal dexamethasone and the growth hormone-insulin-like growth factor axis. Hum Reprod 2000; 15:1403-6. [PMID: 10831578 DOI: 10.1093/humrep/15.6.1403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/14/2022] Open
Abstract
Dexamethasone administration has marked effects on the growth hormone-insulin-like growth factor axis (GH-IGF) in animal and human studies. During pregnancy in the rat, it is associated with fetal growth restriction due to inhibition of IGF bioactivity. In the human only repeated dosages have been associated with fetal growth restriction. The aim of this study is to test the hypothesis that antenatal dexamethasone administration to pregnant women is associated with reduced activity of the GH-IGF axis. To achieve this blood samples were taken from 12 pregnant women pre- and at 24 h and 48 h after dexamethasone administration. In these samples GH, IGF-I, IGF bioactivity and IGF binding protein (IGFBP)-3 protease activity were measured. In view of the interaction between insulin and the GH-IGF axis, glucose and insulin concentrations were also measured. There were no significant differences between the concentrations of GH, IGF-I, IGF bioactivity and IGFBP-3 protease activity before and after dexamethasone. The concentrations of glucose and insulin were significantly higher at 24 h, but not 48 h post-dexamethasone. It is concluded that a single antenatal course of dexamethasone does not alter the GH-IGF-I axis in pregnant women at the time points studied.
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Affiliation(s)
- O Ogueh
- Section of Obstetrics and Gynaecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
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Abstract
PURPOSE The purpose of this study was to evaluate the sensitivity, specificity, and precision of MEDLINE search strategies for detecting randomized controlled trials (RCTs) in prosthodontics. MATERIALS AND METHODS A list of RCTs was obtained by hand-searching the International Journal of Prosthodontics, Journal of Prosthetic Dentistry, and Journal of Prosthodontics published between 1988 and 1997. RCTs identified served as the "gold standard" with which different MEDLINE search strategies were compared. Subject headings, keywords, MEDLINE checktags, publication types, and combinations thereof were used, and their results were compared with the "gold standard". RESULTS Sensitivity ranged from 9% to 67%, specificity was at least 96% for all searches, and precision ranged from 22% to 59%. The most productive searches were by publication type clinical trial and publication type randomized controlled trial. Combining search terms did not improve sensitivity for detecting RCTs published in prosthodontic journals (p > .10). CONCLUSION These findings support the need for more detailed reporting of trial methodologies to facilitate accurate indexing of prosthodontic articles in MEDLINE.
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Affiliation(s)
- H B Dumbrigue
- Department of Prosthodontics, P.O. Box 100435, University of Florida College of Dentistry, Gainesville, FL 32610, USA.
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Abstract
The insulin/IGF binding protein-1 (IGFBP-1) axis is important in coordinating insulin- and IGF-mediated regulation of glucose metabolism and glycemia. Dysregulation of the axis may play a role in the pathophysiology of disorders of insulin deficiency and resistance. We have investigated this hypothesis by generating transgenic mice that overexpress hIGFBP-1. To study the axis in its true physiological context, we used a human (h) IGFBP-1 cosmid clone so that transgene expression is responsive to normal hormonal stimuli. hIGFBP-1 mRNA is expressed in a tissue-specific fashion, and measurement of serum protein levels by specific immunoassay indicates normal physiological regulation in response to fasting/feeding and appropriate post-translational modification as indicated by the detection of phosphorylated and nonphosphorylated isoforms of the protein. The hypoglycemic response to exogenous IGF-I is attenuated in transgenic mice. Transgenic mice exhibit an enhanced insulin secretory response to a glucose challenge, although basal and stimulated blood glucose levels are similar to controls. There is a sexual dimorphism in phenotypic expression: male transgenic mice had higher stimulated glucose and insulin levels than did females. Transgenic mice exhibit fasting hyperglycemia and hyperinsulinemia and glucose intolerance in later life, indicating an age-related decline in glucocompetence. These findings demonstrate the importance of the normal inverse relationship between serum insulin and IGFBP-1 levels in glucoregulation and that sustained dysregulation of the insulin/IGF-I/IGFBP-1 axis is associated with impaired glucose tolerance and abnormalities of insulin action.
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Affiliation(s)
- P A Crossey
- Department of Diabetes, Endocrinology and Internal Medicine, Guy's, King's and St Thomas' School of Medicine, London, UK.
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Abstract
As tools to examine template switches and recombination events during the process of reverse transcription, two nearly identical Moloney murine leukemia virus-based (MoMLV) retroviral vectors were constructed using the technique of recombinatory polymerase chain reaction (PCR). The experimental vectors designed for this study were based on the well-characterized LN series vectors. The protein coding regions normally present in the retroviral genome have been replaced by the coding regions for two drug resistance markers, neomycin phosphotransferase (Neo) and hygromycin phosphotransferase (Hyg). With only one functional drug resistance gene in each vector, the individual vectors as well as recombination events between them can be followed by phenotypic selection. Utilization of recombinatory PCR allowed the insertion of very subtle nucleotide changes resulting in a series of restriction site polymorphisms in the two retroviral vectors. The ability to create these subtle mutations in specific locations of these retroviral vectors allowed the utilization of naturally occurring areas of variability in the vectors and avoid regions important for replication.
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Affiliation(s)
- C R Skinner
- Department of Molecular Pathology, M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Jones JS, Wynne-Edwards KE. Paternal hamsters mechanically assist the delivery, consume amniotic fluid and placenta, remove fetal membranes, and provide parental care during the birth process. Horm Behav 2000; 37:116-25. [PMID: 10753581 DOI: 10.1006/hbeh.1999.1563] [Citation(s) in RCA: 57] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report the first description of a male mammal behaviorally participating in the birth of his young. Djungarian hamsters, Phodopus campbelli, are naturally biparental and males contribute to pup survival and growth through direct paternal care and indirect effects on maternal physiology. Males of the closely related Siberian hamster, P. sungorus, have only seasonal opportunities to interact with pups and neither contribute to pup survival and growth nor provide extensive paternal care under laboratory conditions. Male P. campbelli undergo a series of hormonal changes prior to the birth of their first litter which are not shared with P. sungorus males and may "prime" males to express paternal behavior. We hypothesized that P. campbelli males would behave paternally on first contact with pups during the birth process, whereas P. sungorus males would not. In addition to showing paternal behavior toward neonates, male P. campbelli licked amniotic fluid before the birth, mechanically assisted the delivery, opened an airway by clearing the nostrils (so that pups flushed red with oxygenation), licked and sniffed pups in the moments and minutes after birth to clean the pups of membranes, and ate the placenta. None of these behaviors were observed in P. sungorus. We anticipate that P. campbelli will not be the only species with highly developed paternal behavioral repertoires during the birth.
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Affiliation(s)
- J S Jones
- Department of Biology, Queen's University, Kingston, K7L 3N6, Canada
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Holt RI, Miell JP, Jones JS, Mieli-Vergani G, Baker AJ. Nasogastric feeding enhances nutritional status in paediatric liver disease but does not alter circulating levels of IGF-I and IGF binding proteins. Clin Endocrinol (Oxf) 2000; 52:217-24. [PMID: 10671950 DOI: 10.1046/j.1365-2265.2000.00934.x] [Citation(s) in RCA: 33] [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: 11/20/2022]
Abstract
OBJECTIVE Complications of childhood cirrhosis include abnormal growth and malnutrition, associated with abnormalities in circulating IGFs and IGFBPs. Controlled studies suggest that intensive enteral feeding enhances nutritional status. The aim was to ascertain whether nasogastric feeding improves nutritional status in clinical practice and to assess the effect of feeding on serum IGF-I and IGFBPs. PATIENTS Thirty-three children (median age 0.6 years) with biliary atresia and failure to thrive who were treated with nasogastric feeding. MEASUREMENTS Height, weight and triceps skin fold thickness were measured prior to feeding and regularly for 1 year or until feeding was stopped. Serum IGF-I and IGFBPs were measured by immunoassay at the same intervals. RESULTS The median duration of feeding was 3.7 months. Twenty-two stopped feeding after liver transplantation, while 10 stopped electively and 1 boy died. Before feeding, the children were losing weight and height centile. Triceps skin fold thickness, weight and height SD scores improved with feeding. Baseline serum IGF-I and IGFBP-3 were low, while IGFBP-1 and IGFBP-2 were raised. IGF-I and IGFBP-1 did not change with feeding. IGFBP-2 fell and reached a nadir by 3 months, while IGFBP-3 rose temporarily for 4-6 weeks. CONCLUSIONS Nasogastric feeding improves body composition in paediatric liver disease but circulating IGF-I and IGFBPs remain abnormal and do not play a major role in mediating these changes. This does not exclude a paracrine or autocrine effect of IGF-I.
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Affiliation(s)
- R I Holt
- Department of Medicine, Child Health, King's College School of Medicine and Dentistry, London, UK.
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Dumbrigue HB, Jones JS, Esquivel JF. Developing a register for randomized controlled trials in prosthodontics: results of a search from prosthodontic journals published in the United States. J Prosthet Dent 1999; 82:699-703. [PMID: 10588806 DOI: 10.1016/s0022-3913(99)70011-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM Treatment decisions are often made despite absence of evidence from well-conducted clinical trials. Conclusions about treatment efficacy derived from nonexperimental approaches often overestimate treatment effect. Randomized controlled trials (RCTs) provide the most reliable basis for evaluating effectiveness of treatment interventions. PURPOSE This study attempted to identify and catalog RCTs in prosthodontic journals published in the United States as an initial step in creating a register of clinical trials that would be a resource in setting up systemic overviews of prosthodontic literature. METHODS The International Journal of Prosthodontics, The Journal of Prosthetic Dentistry, and The Journal of Prosthodontics published between 1988 and 1997 were searched manually to identify clinical trials. Clinical trials had to meet the following criteria for inclusion in the register: the trial must involve human subjects, must include at least 2 treatment groups, and treatment group allocation must be randomized. RESULTS A total of 3,631 articles in 196 journal issues were screened. Sixty-two articles (1.7%) met the minimum criteria for inclusion in the RCT register. CONCLUSION Given the lack of randomized controlled trials in prosthodontic journals, a concerted effort by the organized prosthodontic community should be made to screen national and international journals and contribute to the development of a register of randomized controlled trials relevant to prosthodontics.
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Affiliation(s)
- H B Dumbrigue
- College of Dentistry, University of Florida, Gainesville, FL 32610-0435, USA.
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Jones JS. South Africa's health surveyed. S Afr Med J 1999; 89:1130. [PMID: 10599280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
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Jones JS. Human origins in southern Africa? S Afr Med J 1999; 89:1132-3. [PMID: 10599281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
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Genco M, Dunnuck C, Rossman L, Wynn B, Jones JS. Foley catheter balloon technique for visualizing the hymen in adolescent sexual assault victims. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rossman L, Wynn B, Jones JS. The sexual assault examination: A comparison of physical findings between an emergency department and freestanding nurse examiner clinic. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80241-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jones JS. Health priorities in SA. S Afr Med J 1999; 89:1042. [PMID: 10582051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
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Hensley TG, Phillips TC, Jones JS, Kennedy J, Dettmann SK, Chaffee T. Heads or tails: Comparison of a new pacifier thermometer with rectal temperatures in children. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80121-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Jones JS. Co-operation to improve health in southern Africa. S Afr Med J 1999; 89:1045-6. [PMID: 10582053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
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Jones JS. Patients to get rights Charter. S Afr Med J 1999; 89:1049. [PMID: 10582055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
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Abstract
Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a syndrome characterized by an elevated intracranial pressure in the absence of a focal lesion, infective process, or hydrocephalus. New onset IIH may present to the emergency department in a variety of ways. To describe the etiologic associations and clinical features in this disorder, we performed a retrospective analysis of consecutive emergency department patients with new onset IIH during the calendar years 1987-1996. A total of 52 patients met all study criteria. The mean patient age was 27+/-8.9 years; the female-to-male ratio was 7:1. An etiologic association could be identified in 85% of cases and included obesity, hypertension, drugs, endocrine, and systemic disorders. Headache was a dominant complaint in most patients (48/52) and associated with dizziness, nausea, and/or visual complaints. Fourteen patients (27%) were not diagnosed on their initial ED visit and were more likely to have atypical clinical features (71% vs. 24%; P = .004). Atypical features included paraesthesias, neck/back pain, unilateral headache, vertigo, and nystagmus. Papilledema, the ophthalmoscopic hallmark of IIH, was not detected initially in 11 patients (21%). These results suggest that IIH is a relatively uncommon neurological illness that may have a variety of causes. The emergency department diagnosis may be complicated by atypical clinical features and a lack of detectable papilledema.
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Affiliation(s)
- J S Jones
- Department of Emergency Medicine, Butterworth Hospital, Grand Rapids, MI, USA
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