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Patel I, Hall LA, Osei-Bordom D, Hodson J, Bartlett D, Chatzizacharias N, Dasari BVM, Marudanayagam R, Raza SS, Roberts KJ, Sutcliffe RP. Risk factors for failure to rescue after hepatectomy in a high-volume UK tertiary referral center. Surgery 2024; 175:1329-1336. [PMID: 38383242 DOI: 10.1016/j.surg.2024.01.025] [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] [Received: 12/02/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Mortality after severe complications after hepatectomy (failure to rescue) is strongly linked to center volume. The aim of this study was to evaluate the risk factors for failure to rescue after hepatectomy in a high-volume center. METHODS Retrospective study of 1,826 consecutive patients who underwent hepatectomy from 2011 to 2018. The primary outcome was a 90-day failure to rescue, defined as death within 90 days posthepatectomy after a severe (Clavien-Dindo grade 3+) complication. Risk factors for 90-day failure to rescue were evaluated using a multivariable binary logistic regression model. RESULTS The cohort had a median age of 65.3 years, and 56.6% of patients were male. The commonest indication for hepatectomy was colorectal metastasis (58.9%), and 46.9% of patients underwent major or extra-major hepatectomy. Severe complications developed in 209 patients (11.4%), for whom the 30- and 90-day failure to rescue rates were 17.0% and 35.4%, respectively. On multivariable analysis, increasing age (P = .006) and modified Frailty Index (P = .044), complication type (medical or combined medical/surgical versus surgical; P < .001), and body mass index (P = .018) were found to be significant independent predictors of 90-day failure to rescue. CONCLUSION Older and frail patients who experience medical complications are particularly at risk of failure to rescue after hepatectomy. These results may inform preoperative counseling and may help to identify candidates for prehabilitation. Further study is needed to assess whether failure to rescue rates could be reduced by perioperative interventions.
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Affiliation(s)
- Ishaan Patel
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Lewis A Hall
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, UK
| | | | - James Hodson
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, UK
| | | | | | | | | | - Syed S Raza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
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Powell-Brett S, Halle-Smith JM, Hall LA, Hodson J, Phillips ME, Roberts KJ. Comprehensive, long-term evaluation of pancreatic exocrine insufficiency after pancreatoduodenectomy. Pancreatology 2024; 24:298-305. [PMID: 38216353 DOI: 10.1016/j.pan.2023.11.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/14/2024]
Abstract
AIMS Treatment of pancreatic exocrine insufficiency (PEI) following pancreatoduodenectomy (PD) improves quality of life, clinical outcomes, and survival. However, diagnosing PEI following PD is challenging owing to the difficulties with current tests and often non-specific symptoms. This work aims to quantify the true rate of long-term PEI in patients following a PD. METHODS Patients underwent a PEI screen approximately one to two years following PD for oncologic indication, including the 13C Mixed triglyceride breath test (13CMTGT), faecal elastase 1 (FE-1) and the PEI Questionnaire (PEI-Q). Four reviewers with expertise in PEI reviewed the results blinded to other decisions to classify PEI status; disagreements were resolved on consensus. RESULTS 26 patients were recruited. Of those with valid test results, these were indicative of PEI based on pre-specified thresholds for 60 % (15/25) for the 13CMTGT, 82 % (18/22) for FE-1, and 88 % (22/25) for the PEI-Q. After discussion between reviewers, the consensus PEI prevalence was 81 % (95 % CI: 61-93 %; 21/26), with 50 % (N = 13) classified as having severe, 23 % (N = 6) moderate, and 8 % (N = 2) mild PEI. DISCUSSION Since no ideal test exists for PEI, this collation of diagnostic modalities and blinded expert review was designed to ascertain the true rate of long-term PEI following PD. This required our cohort to survive a year, travel to hospital, and undergo a period of starvation and PERT hold, and therefore there is likely to be recruitment bias towards fitter, younger patients with less aggressive pathology. Despite this, over 80 % were deemed to have PEI, with over 90 % of these being considered moderate or severe.
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Affiliation(s)
- Sarah Powell-Brett
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; School of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | - James M Halle-Smith
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; School of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Lewis A Hall
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; School of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - James Hodson
- Research Development and Innovation, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Mary E Phillips
- University of Surrey, School of Biosciences and Medicine, UK
| | - Keith J Roberts
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; School of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Halle-Smith JM, Pearce H, Nicol S, Hall LA, Powell-Brett SF, Beggs AD, Iqbal T, Moss P, Roberts KJ. Involvement of the Gut Microbiome in the Local and Systemic Immune Response to Pancreatic Ductal Adenocarcinoma. Cancers (Basel) 2024; 16:996. [PMID: 38473357 DOI: 10.3390/cancers16050996] [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] [Received: 01/12/2024] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
The systemic and local immunosuppression exhibited by pancreatic ductal adenocarcinoma (PDAC) contributes significantly to its aggressive nature. There is a need for a greater understanding of the mechanisms behind this profound immune evasion, which makes it one of the most challenging malignancies to treat and thus one of the leading causes of cancer death worldwide. The gut microbiome is now thought to be the largest immune organ in the body and has been shown to play an important role in multiple immune-mediated diseases. By summarizing the current literature, this review examines the mechanisms by which the gut microbiome may modulate the immune response to PDAC. Evidence suggests that the gut microbiome can alter immune cell populations both in the peripheral blood and within the tumour itself in PDAC patients. In addition, evidence suggests that the gut microbiome influences the composition of the PDAC tumour microbiome, which exerts a local effect on PDAC tumour immune infiltration. Put together, this promotes the gut microbiome as a promising route for future therapies to improve immune responses in PDAC patients.
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Affiliation(s)
- James M Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Hayden Pearce
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Samantha Nicol
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Lewis A Hall
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Sarah F Powell-Brett
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Andrew D Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Tariq Iqbal
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
- Microbiome Treatment Centre, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham B15 2TT, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Keith J Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
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4
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Powell-Brett S, Hall LA, Roberts KJ. A standardised nutritional drink as a test meal for the 13 C mixed triglyceride breath test for pancreatic exocrine insufficiency: A randomised, two-arm crossover comparative study. J Hum Nutr Diet 2024; 37:137-141. [PMID: 37723653 DOI: 10.1111/jhn.13237] [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: 06/19/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND The 13 C mixed triglyceride breath test (13 C MTGT) is a diagnostic test for pancreatic exocrine insufficiency (PEI). It is poorly standardised with much heterogeneity of the test meal, the commonest being toast and butter. A standardised oral nutritional supplement that could be easily transported, stored and made up would be valuable for making this test accessible outside of specialist centres. METHODS A prospective, randomised, two-arm crossover study of different test meals was carried out in 14 healthy controls. The 13 C MTGT was performed in identical conditions on two separate days. Two test meals were given in random order, either standard (toast and butter) or novel (oral nutritional supplement), with 250 mg of 13 C-labelled mixed triglyceride incorporated. Breath samples were taken postprandially to calculate cumulative percentage dose recovery (cPDR) of 13 C at 6 h. RESULTS All 14 participants completed both arms of the study with no protocol deviations. The mean cPDR was 39.39% (standard deviation [SD] 5.19) for the standard test meal and 39.93% (SD 5.20) for the novel test meal. A one-way repeated measures analysis of variance (ANOVA) found no significant difference in cPDR between the two meals, F(1, 13) = 0.18, p = 0.68 (minimum detectable difference of 0.81 at 80% power). CONCLUSION This study demonstrates that a standardised oral nutritional supplement can be used without compromising 13 C recovery. Using this test meal provides a standardised dietary stimulus to the pancreas, avoiding possible variation in quantity of dietary components with other test meals. Further, the ease of use of this method would help establish the 13 C MTGT test more widely.
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Affiliation(s)
- Sarah Powell-Brett
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Lewis A Hall
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Keith J Roberts
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
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5
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Hall LA, Powell-Brett S, Halle-Smith J, Ward L, Wiggins T, Markar SR, Roberts KJ. Pancreatic exocrine insufficiency after non-pancreatic upper gastrointestinal surgery: meta-analysis. Br J Surg 2024; 111:znad369. [PMID: 38064682 DOI: 10.1093/bjs/znad369] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/12/2023] [Accepted: 10/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Untreated pancreatic exocrine insufficiency (PEI) results in substantial patient harm. Upper gastrointestinal surgery (bariatric metabolic surgery and oesophagogastric resection) affects the delicate physiology of pancreatic exocrine function and may result in PEI. The aim of this study was to assimilate the literature on incidence, diagnosis, and management of PEI after bariatric metabolic surgery and oesophagogastric resection. METHODS A systematic review of PubMed, MEDLINE, and Embase databases identified studies investigating PEI after non-pancreatic upper gastrointestinal surgery. Meta-analyses were undertaken for incidence of PEI and benefit of pancreatic enzyme replacement therapy. RESULTS Among 1620 patients from 24 studies included in quantitative synthesis, 36.0% developed PEI. The incidence of PEI was 23.0 and 50.4% after bariatric metabolic surgery and oesophagogastric resection respectively. Notably, the incidence of PEI was 44% after biliopancreatic diversion with duodenal switch and 66.2% after total gastrectomy. The most common diagnostic test used was faecal elastase 1 (15 of 31 studies), with less than 200 µg/g being diagnostic of PEI. A total of 11 studies considered the management of pancreatic exocrine insufficiency, with 78.6% of patients responding positively to pancreatic enzyme replacement when it was prescribed. CONCLUSION PEI is common after non-pancreatic upper gastrointestinal surgery and patients may benefit from enzyme replacement therapy.
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Affiliation(s)
- Lewis A Hall
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
- College of Medical and Dental Scientists, University of Birmingham, Birmingham, UK
| | - Sarah Powell-Brett
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | - James Halle-Smith
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | - Liz Ward
- Department Therapies and Dietetics, Churchill Hospital, Oxford University Hospitals Foundation NHS Trust, Oxford, UK
| | - Tom Wiggins
- Department of Bariatric Surgery and Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Sheraz R Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Keith J Roberts
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
- College of Medical and Dental Scientists, University of Birmingham, Birmingham, UK
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Halle-Smith JM, Hall LA, Powell-Brett SF, Merali N, Frampton AE, Beggs AD, Moss P, Roberts KJ. Pancreatic Exocrine Insufficiency and the Gut Microbiome in Pancreatic Cancer: A Target for Future Diagnostic Tests and Therapies? Cancers (Basel) 2023; 15:5140. [PMID: 37958314 PMCID: PMC10649877 DOI: 10.3390/cancers15215140] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Pancreatic exocrine insufficiency (PEI) is common amongst pancreatic cancer patients and is associated with poorer treatment outcomes. Pancreatic enzyme replacement therapy (PERT) is known to improve outcomes in pancreatic cancer, but the mechanisms are not fully understood. The aim of this narrative literature review is to summarise the current evidence linking PEI with microbiome dysbiosis, assess how microbiome composition may be impacted by PERT treatment, and look towards possible future diagnostic and therapeutic targets in this area. Early evidence in the literature reveals that there are complex mechanisms by which pancreatic secretions modulate the gut microbiome, so when these are disturbed, as in PEI, gut microbiome dysbiosis occurs. PERT has been shown to return the gut microbiome towards normal, so called rebiosis, in animal studies. Gut microbiome dysbiosis has multiple downstream effects in pancreatic cancer such as modulation of the immune response and the response to chemotherapeutic agents. It therefore represents a possible future target for future therapies. In conclusion, it is likely that the gut microbiome of pancreatic cancer patients with PEI exhibits dysbiosis and that this may potentially be reversible with PERT. However, further human studies are required to determine if this is indeed the case.
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Affiliation(s)
- James M. Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK (K.J.R.)
- Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2GW, UK;
| | - Lewis A. Hall
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK (K.J.R.)
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Sarah F. Powell-Brett
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK (K.J.R.)
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Nabeel Merali
- Section of Oncology, Department of Clinical & Experimental Medicine, University of Surrey, Guildford GU2 7WG, UK (A.E.F.); (P.M.)
- Minimal Access Therapy Training Unit (MATTU), Leggett Building, University of Surrey, Guildford GU2 7WG, UK
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
| | - Adam E. Frampton
- Section of Oncology, Department of Clinical & Experimental Medicine, University of Surrey, Guildford GU2 7WG, UK (A.E.F.); (P.M.)
- Minimal Access Therapy Training Unit (MATTU), Leggett Building, University of Surrey, Guildford GU2 7WG, UK
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
| | - Andrew D. Beggs
- Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2GW, UK;
- Colorectal Surgery Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Paul Moss
- Section of Oncology, Department of Clinical & Experimental Medicine, University of Surrey, Guildford GU2 7WG, UK (A.E.F.); (P.M.)
| | - Keith J. Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK (K.J.R.)
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
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Halle-Smith JM, Hall LA, Hann A, Isaac JL, Murphy N, Roberts KJ, Rajoriya N, Perera MTPR. Emergency retransplant for primary non-function of liver allograft. Br J Surg 2023; 110:1267-1270. [PMID: 37134006 DOI: 10.1093/bjs/znad110] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Affiliation(s)
- James M Halle-Smith
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, University of Birmingham, Edgbaston, UK
| | - Lewis A Hall
- Centre for Liver and Gastrointestinal Research, University of Birmingham, Edgbaston, UK
| | - Angus Hann
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, University of Birmingham, Edgbaston, UK
| | - John L Isaac
- Department of Anaesthesia and Critical care, Queen Elizabeth Hospital, Birmingham, UK
| | - Nick Murphy
- Department of Anaesthesia and Critical care, Queen Elizabeth Hospital, Birmingham, UK
| | - Keith J Roberts
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, University of Birmingham, Edgbaston, UK
| | - Neil Rajoriya
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, University of Birmingham, Edgbaston, UK
| | - M Thamara P R Perera
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, University of Birmingham, Edgbaston, UK
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Hall LA, Jackson R, Soccorso G, Lander AD, Pachl MJ. Assessment of jejunal interposition perfusion using indocyanine green. Photodiagnosis Photodyn Ther 2023; 43:103687. [PMID: 37399912 DOI: 10.1016/j.pdpdt.2023.103687] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Jejunal interposition (JI) is an option for oesophageal replacement in children; ensuring good graft perfusion is essential. We report three cases where Indocyanine Green (ICG) with Near-Infrared Fluorescence (NIRF) was used to assess perfusion during graft selection, passage into the chest and anastomotic assessment. This extra assessment may reduce risk of anastomotic leak and/or stricture. METHODS We describe the technique and salient features of all patients who have undergone ICG/NIRF-assisted JI in our centre. Patient demographics, indications for surgery, intra-operative plan, video of NIR perfusion assessment, complications and outcomes were reviewed. RESULTS ICG/NIRF was used in three patients (2M:1F) at a dose of 0.2 mg/kg. ICG/NIRF imaging helped select the jejunal graft and confirmed perfusion after division of segmental arteries. Perfusion was assessed before and after passing the graft through the diaphragmatic hiatus and before and after making the oesophago-jejunal anastomosis. Intrathoracic assessment at the end of the procedure confirmed good perfusion of mesentery and intrathoracic bowel. In two patients, the reassurance contributed to successful procedures. In the third patient, graft selection was satisfactory, but borderline perfusion on clinical assessment after passing the graft to the chest, confirmed by ICG/NIRF meant the graft was abandoned. CONCLUSIONS ICG/NIRF imaging was feasible and augmented our subjective assessment of graft perfusion, giving greater confidence during graft preparation, movement, and anastomosis. In addition, the imaging helped us abandon one graft. This series demonstrates the feasibility and benefit of ICG/NIR use in JI surgery. Further studies are required to optimise ICG use in this setting.
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Affiliation(s)
- Lewis A Hall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Raef Jackson
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK
| | - Giampiero Soccorso
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK
| | - Anthony D Lander
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK
| | - Max J Pachl
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK; Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.
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Hall LA, McKay SC, Halle-Smith J, Soane J, Osei-Bordom DC, Goodburn L, Magill L, Pinkney T, Radhakrishna G, Valle JW, Corrie P, Roberts KJ. The impact of the COVID-19 pandemic upon pancreatic cancer treatment (CONTACT Study): a UK national observational cohort study. Br J Cancer 2023; 128:1922-1932. [PMID: 36959376 PMCID: PMC10035482 DOI: 10.1038/s41416-023-02220-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION CONTACT is a national multidisciplinary study assessing the impact of the COVID-19 pandemic upon diagnostic and treatment pathways among patients with pancreatic ductal adenocarcinoma (PDAC). METHODS The treatment of consecutive patients with newly diagnosed PDAC from a pre-COVID-19 pandemic cohort (07/01/2019-03/03/2019) were compared to a cohort diagnosed during the first wave of the UK pandemic ('COVID' cohort, 16/03/2020-10/05/2020), with 12-month follow-up. RESULTS Among 984 patients (pre-COVID: n = 483, COVID: n = 501), the COVID cohort was less likely to receive staging investigations other than CT scanning (29.5% vs. 37.2%, p = 0.010). Among patients treated with curative intent, there was a reduction in the proportion of patients recommended surgery (54.5% vs. 76.6%, p = 0.001) and increase in the proportion recommended upfront chemotherapy (45.5% vs. 23.4%, p = 0.002). Among patients on a non-curative pathway, fewer patients were recommended (47.4% vs. 57.3%, p = 0.004) or received palliative anti-cancer therapy (20.5% vs. 26.5%, p = 0.045). Ultimately, fewer patients in the COVID cohort underwent surgical resection (6.4% vs. 9.3%, p = 0.036), whilst more patients received no anti-cancer treatment (69.3% vs. 59.2% p = 0.009). Despite these differences, there was no difference in median overall survival between the COVID and pre-COVID cohorts, (3.5 (IQR 2.8-4.1) vs. 4.4 (IQR 3.6-5.2) months, p = 0.093). CONCLUSION Pathways for patients with PDAC were significantly disrupted during the first wave of the COVID-19 pandemic, with fewer patients receiving standard treatments. However, no significant impact on survival was discerned.
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Affiliation(s)
- Lewis A Hall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, England.
| | - Siobhan C McKay
- Queen Elizabeth Hospital, Birmingham, England
- Department of Academic Surgery, University of Birmingham, Birmingham, England
| | | | - Joshua Soane
- Southend University Hospital, Southend-on-Sea, England
| | | | | | - Laura Magill
- Birmingham Surgical Trials Consortium, University of Birmingham, Birmingham, England
| | - Thomas Pinkney
- Birmingham Surgical Trials Consortium, University of Birmingham, Birmingham, England
| | | | - Juan W Valle
- The Christie NHS Foundation Trust, Manchester, England
| | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Keith J Roberts
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, England
- Queen Elizabeth Hospital, Birmingham, England
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Halle-Smith JM, Powell-Brett SF, Hall LA, Duggan SN, Griffin O, Phillips ME, Roberts KJ. Recent Advances in Pancreatic Ductal Adenocarcinoma: Strategies to Optimise the Perioperative Nutritional Status in Pancreatoduodenectomy Patients. Cancers (Basel) 2023; 15:cancers15092466. [PMID: 37173931 PMCID: PMC10177139 DOI: 10.3390/cancers15092466] [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] [Received: 03/26/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy for which the mainstay of treatment is surgical resection, followed by adjuvant chemotherapy. Patients with PDAC are disproportionately affected by malnutrition, which increases the rate of perioperative morbidity and mortality, as well as reducing the chance of completing adjuvant chemotherapy. This review presents the current evidence for pre-, intra-, and post-operative strategies to improve the nutritional status of PDAC patients. Such preoperative strategies include accurate assessment of nutritional status, diagnosis and appropriate treatment of pancreatic exocrine insufficiency, and prehabilitation. Postoperative interventions include accurate monitoring of nutritional intake and proactive use of supplementary feeding methods, as required. There is early evidence to suggest that perioperative supplementation with immunonutrition and probiotics may be beneficial, but further study and understanding of the underlying mechanism of action are required.
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Affiliation(s)
- James M Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Sarah F Powell-Brett
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Lewis A Hall
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Sinead N Duggan
- Department of Surgery, Trinity College Dublin, University of Dublin, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Oonagh Griffin
- Department of Nutrition and Dietetics, St. Vincent's University Hospital, D04 T6F4 Dublin, Ireland
| | - Mary E Phillips
- Department of Nutrition and Dietetics, Royal Surrey County Hospital, Guildford GU2 7XX, UK
| | - Keith J Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
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Hall LA, Powell-Brett S, Thompson O, Smith D, Bradley E, Smith S, Vickrage S, Kemp-Blake J, Roberts KJ, Shah T. Casting a Wider NET: Pancreatic Exocrine Insufficiency Induced by Somatostatin Analogues among Patients with Neuroendocrine Tumours? Cancers (Basel) 2023; 15:cancers15071933. [PMID: 37046594 PMCID: PMC10093494 DOI: 10.3390/cancers15071933] [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] [Received: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Somatostatin-analogues (SSAs) are a first-line treatment of unresectable neuroendocrine tumours (NETs). However, SSAs inhibit pancreatic secretions, which could lead to pancreatic exocrine insufficiency (PEI). PEI is known to be detrimental to patient quality of life and nutritional status. This study aimed to evaluate the effect of SSAs on pancreatic exocrine function in patients with NETs, using the 13C-mixed triglyceride breath test (13C-MTGT). Exocrine function was assessed using the 13C-MTGT at baseline and after a third SSA injection (two months). A quotient of 13CO2/12CO2 was measured by mass spectrometry, and the cumulative percent dose recovered at 6 h (cPDR) is reported. The secondary endpoints investigated were change in weight, HbA1C, and vitamin D levels. Ten patients completed the study. Exocrine function reduced in all patients (n = 10) following SSA therapy (median reduction from baseline: -23.4% (range: -42.1-0.5%, p = 0.005)). vitamin D levels decreased in all but one patient (median decrease from baseline: -26.5%, (-44.7-10%; p = 0.038)), and median HbA1C levels increased by 8.0% (0-59.3%; p = 0.008). Change in weight was not significant (median decrease from baseline: -0.21% (-4.5-3.5%, p = 1.000)). SSA therapy has a consistent impact on exocrine function from early in the treatment course, but the long-term clinical effects of this remain to be defined. Further studies are required to determine the clinical relevance of this observation and optimise the management of PEI in this cohort.
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Affiliation(s)
- Lewis A Hall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Sarah Powell-Brett
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- The Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Oscar Thompson
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Daniel Smith
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Elizabeth Bradley
- Department of Nutrition and Dietetics, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Stacey Smith
- Birmingham Neuroendocrine Tumour Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Suzanne Vickrage
- Birmingham Neuroendocrine Tumour Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Joanne Kemp-Blake
- Birmingham Neuroendocrine Tumour Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Keith J Roberts
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- The Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Tahir Shah
- Birmingham Neuroendocrine Tumour Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
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Halle-Smith JM, Hall LA, Mirza DF, Roberts KJ. Risk factors for anastomotic stricture after hepaticojejunostomy for bile duct injury-A systematic review and meta-analysis. Surgery 2021; 170:1310-1316. [PMID: 34148708 DOI: 10.1016/j.surg.2021.05.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND After major bile duct injury, hepaticojejunostomy can result in good long-term patency, but anastomotic stricture is a common cause of long-term morbidity. There is a need to assimilate high-level evidence to establish risk factors for development of anastomotic stricture after hepaticojejunostomy for bile duct injury. METHODS A systematic review of studies reporting the rate of anastomotic stricture after hepaticojejunostomy for bile duct injury was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses of proposed risk factors were then performed. RESULTS Meta-analysis included 5 factors (n = 2,155 patients, 17 studies). Concomitant vascular injury (odds ratio 4.96; 95% confidence interval 1.92-12.86; P = .001), postrepair bile leak (odds ratio: 8.03; 95% confidence interval 2.04-31.71; P = .003), and repair by nonspecialist surgeon (odds ratio 11.29; 95% confidence interval 5.21-24.47; P < .0001) increased the rate of anastomotic stricture of hepaticojejunostomy after bile duct injury. Level of injury according to the Strasberg Grade did not significantly affect the rate of anastomotic stricture (odds ratio: 0.97; 95% confidence interval 0.45-2.10; P = .93). Owing to heterogeneity of reporting, it was not possible to perform a meta-analysis for the impact of timing of repair on anastomotic stricture rate. CONCLUSION The only modifiable risk factor, repair by a nonspecialist surgeon, demonstrates the importance of broad awareness of these data. Knowledge of these risk factors may permit risk stratification of follow-up, better informed consent, and understanding of prognosis.
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Affiliation(s)
- James M Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, United Kingdom. https://twitter.com/jameshallesmith
| | - Lewis A Hall
- College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - Darius F Mirza
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, United Kingdom. https://twitter.com/DrDariusMirza
| | - Keith J Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, United Kingdom.
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Hall LA. The archives of the Pioneer Health Centre, Peckham, in the Wellcome Library. Soc Hist Med 2001; 14:525-538. [PMID: 11811192 DOI: 10.1093/shm/14.3.525] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article gives a brief description of this important British experiment in health and community (1926-50) and the historiography relating to it. The archives, which are now in the Wellcome Library, are described. While mention is made of the gaps in the record (and the possible reasons for them), the strengths of the collection are indicated.
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Affiliation(s)
- L A Hall
- Wellcome Library for the History and Understanding of Medicine, The Wellcome Trust, London, UK.
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15
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Hall LA. A "remarkable collection": The Papers of Frederick Parkes Weber FRCP (1863-1962). Med Hist 2001; 45:523-532. [PMID: 11688256 PMCID: PMC1044425] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- L A Hall
- Wellcome Library for the History and Understanding of Medicine, 183 Euston Road, London NW1 2BE
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Abstract
The authors tested the long-term effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self-esteem in 92 college women aged 18 to 24 years who ere at risk for clinical depression. The women were randomly assigned to either an experimental or a no-treatment control group. The experimental group participated in a 6-week cognitive-behavioral intervention that targeted identification and reduction of negative thinking, using such techniques as thought stopping and affirmations. Data on depressive symptoms, self-esteem, and negative thinking were collected before the intervention and at intervals of 1, 6, and 18 months postintervention. The women in the intervention group experienced a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem than those in the control group. The beneficial effects continued over an 18-month follow-up period. These findings support the importance of thought stopping and affirmations as prevention interventions with at-risk college women.
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Affiliation(s)
- A R Peden
- College of Nursing, University of Kentucky, Lexington, USA.
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Hall LA. 'Not a domestic utensil but a woman and a citizen': Stella Browne on women, health and society. Clio Med 2001; 60:275-302. [PMID: 11142150 DOI: 10.1163/9789004333345_011] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Krauthauser CM, Hall LA, Wexler RS, Slee AM, Mitra J, Enders GH, Kerr JS. Regulation of gene expression and cell growth in vivo by tetracycline using the hollow fiber assay. Anticancer Res 2001; 21:869-72. [PMID: 11396177] [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: 02/20/2023]
Abstract
The hollow fiber assay presents a potentially unique tool to study the effects of regulated gene expression in cell lines that do not form tumors in vivo. The hollow fibers allow small molecules to pass freely through while keeping the cells within the fibers and segregated from host cells. OSp16.1 cells, derived from the U24 clone of the U2-OS osteogenic sarcoma tumor line, express the p16INK4a tumor suppressor under the regulation of tetracycline (tet) (Mitra J et al. Mol Cell Bio 19:3916, 1999). The in vitro induction of p16 in the OSp16.1 cell line is regulated by tet. The hollow fiber assay was used to determine whether the regulation of the p16 gene could be achieved in vivo, since these cells did not grow in the xenograft model. There were no differences in the in vivo growth pattern of U24 cells loaded into the hollow fibers with and without tet: 807% and 839% net growth, respectively. OSp16.1 cells in fibers in mice receiving 3.33 mg/kg/day tet had a 644% net growth after 21 days. There was a 194% net growth without tet. Immunoblotting of extracts prepared from the hollow fibers confirmed that p16 was induced in the absence of tet. These data demonstrate this assay is a useful tool for studying the effects of regulated gene expression in vivo.
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Affiliation(s)
- C M Krauthauser
- DuPont Pharmaceuticals Co., Route 141 and Henry Clay Road, PO Box 80400, Wilmington, DE 19880-0400, USA
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Abstract
The purpose of this study was to examine the association of the quality of caregiver relationships with the psychological well-being of elderly care-recipients. Sociodemographic variables and characteristics of the care-recipient situation (e.g., self-rated physical health, amount of instrumental support needed) were explored as potential predictors of the psychological well-being of elderly individuals. A secondary analysis of data collected during in-home interviews with 37 community-dwelling older adults revealed no significant correlations between the quality of the primary intimate relationship and any dimension of psychological well-being. However, better self-rated health was associated with fewer depressive symptoms, higher morale, greater life satisfaction, and better quality of life. The more instrumental support needed by an individual, the greater their depressive symptoms and the lower their morale. The findings also revealed that the older the individual was, the greater the depressive symptoms were and the lower life satisfaction became. Self-rated physical health predicted each dimension of psychological well-being. The findings suggest that age, the amount of instrumental support needed, and perceptions of physical health are important indicators of the psychological well-being of elderly care-recipients.
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Affiliation(s)
- B L Nunley
- Health Sciences Center, West Virginia University School of Nursing, Charleston Division, 25304-1299, USA
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20
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Williams AR, Alleyne BD, Hall LA, White AJ, Williams DJ, Thompson LK. Synthesis and structures of polymeric Mn, Co, Cu, and Zn complexes of 3-diphenylamino-4-hydroxycyclobut-3-ene-1,2-dione (diphenylaminosquarate) and of the salt [Ni(H2O)6][(C6H5)2NC4O3]2.2H2O. Inorg Chem 2000; 39:5265-70. [PMID: 11187469 DOI: 10.1021/ic000390q] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Reaction of M(NO3)2.xH2O (M = Mn, Co, Ni, Cu, Zn) with 3-diphenylamino-4-hydroxycyclobut-3-ene-1,2-dione (diphenylaminosquarate) produces the neutral polymeric species (M[mu-(C6H5)2NC4O3]2[H2O]2)n [M = Mn (1), Cu (2)]; (M[mu-(C6H5)2NC4O3][(C6H5)2NC4O3][H2O]3)n [M = Co (3), Zn (4)]; and in the case of Ni, the salt [Ni(H2O)6][(C6H5)2NC4O3]2.2H2O (5). Complexes 1 and 2 are isomorphous and crystallize in the monoclinic space group P2(1)/c with, for 1, a = 13.138(1) A, b = 10.900(2) A, c = 9.269(2) A, beta = 96.07(1) degrees, and Z = 2. Complexes 3 and 4 are also isomorphous and crystallize in the space group P2(1)/c with, for 3, a = 13.211(1) A, b = 11.038(1) A, c = 18.748(1) A, beta = 97.75(1) degrees, and Z = 4. The nickel salt, 5, crystallizes in the triclinic space group P1 with a = 6.181(1) A, b = 9.417(1) A, c = 15.486(1) A, alpha = 101.37(1) degrees, beta = 95.51(1) degrees, gamma = 107.57(1) degrees, and Z = 1. In 1 and 2, the metal coordination is octahedral, comprising four mu-1,3-bridging diphenylaminosquarate ligands and two trans aqua ligands. In 3 and 4, the metal coordination is again octahedral, comprising two mu-1,3-bridging and one pendant diphenylaminosquarate ligands, the octahedron being completed by three aqua ligands in a meridional configuration. In 5, the hexaaquanickel(II) ion is linked by O-H...O hydrogen bonds to a pair of diphenylaminosquarate anions. These anion-cation units are linked via included water molecules to form hydrogen-bonded chains. The diphenylaminosquarate ligands in the polymeric complexes 1-4 display multiple-bond localization, a feature which is absent in 5. Complex 1 exhibits weak antiferromagnetic coupling, whereas 2 shows no significant magnetic interactions.
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Affiliation(s)
- A R Williams
- Department of Chemistry, University of the West Indies, St. Augustine, Trinidad, West Indies
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21
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Henry CA, Hall LA, Burr Hille M, Solnica-Krezel L, Cooper MS. Somites in zebrafish doubly mutant for knypek and trilobite form without internal mesenchymal cells or compaction. Curr Biol 2000; 10:1063-6. [PMID: 10996075 DOI: 10.1016/s0960-9822(00)00677-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vertebrates, paraxial mesoderm is partitioned into repeating units called somites. It is thought that the mechanical forces arising from compaction of the presumptive internal cells of prospective somites cause them to detach from the unsegmented presomitic mesoderm [1-3]. To determine how prospective somites physically segregate from each other, we used time-lapse microscopy to analyze the mechanics underlying early somitogenesis in wild-type zebrafish and in the mutants trilobite(m209) (tri), knypek(m119) (kny), and kny;tri, which are defective in convergent extension during gastrulation. Formation of somite boundaries in all of these embryos involved segregation, local alignment, and cell-shape changes of presumptive epitheloid border cells along nascent intersomitic boundaries. Although kny;tri somites formed without convergence of the presomitic mesoderm and were composed of only two cells in their anteroposterior (AP) dimension, they still exhibited AP intrasegmental polarity. Furthermore, morphogenesis of somite boundaries in these embryos proceeded in a manner similar to that in wild-type embryos. Thus, intersomitic boundary formation in zebrafish involves short-range movements of presumptive border cells that do not require mechanical forces generated by internal cells or compaction of the presomitic mesoderm.
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Affiliation(s)
- C A Henry
- Department of Zoology, University of Washington, Seattle, 98195-1800, USA.
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22
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Abstract
PURPOSE Although cognitive-behavioral interventions have been successful in treating depression, no studies were found that focused solely on reducing negative thinking via group intervention as a means of preventing depression in at-risk groups. The purpose of this randomized controlled trial was to test the effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self-esteem in young women at risk for depression. DESIGN A randomized controlled trial with 92 college women ages 18 to 24 who were at risk for depression was conducted. METHOD Participants were randomly assigned to either the control or experimental group. The experimental group participated in a 6-week cognitive-behavioral group intervention. Data on self-esteem, depressive symptoms, and negative thinking were collected via self-report questionnaires from control and experimental groups at baseline, 1 month after the intervention, and at 6-month follow-up. Data were analyzed using mixed-model methodology and the Cochran-Mantel-Haenszel chi-square test. FINDINGS Compared to those in the control group, women who received the intervention had a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem, and these beneficial effects were maintained over 6-months. CONCLUSIONS The findings document the effectiveness of this cognitive-behavioral group intervention and indicate empirical support for the beneficial effects of reducing negative thinking by the use of affirmations and thought-stopping techniques on women's mental health.
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Affiliation(s)
- A R Peden
- College of Nursing, University of Kentucky, Lexington 40536-0232, USA.
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Abstract
BACKGROUND One of every three women between 18 and 24 years of age may be significantly depressed. Younger women have shown increasing rates of unipolar depression since the 1950s, and the average age of onset continues to decline. OBJECTIVES To examine the prevalence and correlates of high depressive symptoms in single college women 18 to 24 years of age. Negative thinking was posited to mediate the relationship between self-esteem and depressive symptoms. METHODS A sample of 246 women was recruited from a university student body. Each woman completed a survey that included the Center for Epidemiologic Studies-Depression Scale, the Beck Depression Inventory, the Rosenberg Self-esteem Scale, the Crandell Cognitions Inventory, and the Automatic Thoughts Questionnaire. RESULTS Of the women, 35% had high depressive symptoms. Negative thinking mediated the relationship between self-esteem and depressive symptoms. However, self-esteem also showed a weak direct effect on depressive symptoms. CONCLUSION The findings suggest that negative thinking may play an important role in the development of depressive symptoms in college women.
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Affiliation(s)
- A R Peden
- College of Nursing, University of Kentucky, Lexington 40536-0232, USA
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24
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Hall LA, Krauthauser CM, Wexler RS, Hollingshead MG, Slee AM, Kerr JS. The hollow fiber assay: continued characterization with novel approaches. Anticancer Res 2000; 20:903-11. [PMID: 10810375] [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: 02/16/2023]
Abstract
The hollow fiber assay, a unique in vivo model, permits the simultaneous evaluation of compound efficacy against multiple cell lines in two physiological compartments. This assay has been used to characterize in vivo activity of cytotoxic compounds. The purpose of the present study was to characterize and optimize this assay for compounds with a defined mechanism of action, specifically cell cycle inhibition. Two human tumor cell lines and one normal human cell line were loaded into polyvinylidene fluoride hollow fibers at two or more cell concentrations and grown in mice for 3-10 days. The data demonstrate the importance of characterizing the initial loading density of various cell lines in the evaluation of compounds. All studies were performed with cells in the linear part of the cell growth curves. Initial loading densities of 1-2 x 10(4) cells/fiber gave the greatest opportunity for growth in the three human cell lines tested (HCT116 colon carcinoma, NCI-H460 non-small cell carcinoma, and AG 1523 normal fibroblast). Utilizing the MTT assay, standard curves were constructed to correlate the final number of cells with optical density (OD) readings at 540 nm in order to calculate cell numbers in the fibers. Insights into the mechanism of action of cisplatin have been gained using Western blot analysis of the cell cycle markers PCNA (a protein present throughout the cell cycle) and Rb (a protein that acts as a tumor suppressor gene product) from the hollow fiber cells. In cisplatin-treated NCI-H460 cells both PCNA and Rb phosphorylation decreased, suggesting the arrest of the cells prior to the S phase. Standard therapeutic agents, cisplatin, racemic flavopiridol, cyclophosphamide and mitomycin C, were evaluated independently in the hollow fiber assay and the xenograft model. The data demonstrate that compounds active in the hollow fiber assay are also active in the xenograft.
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Affiliation(s)
- L A Hall
- DuPont Pharmaceuticals Co., Wilmington, DE 19880-0400, USA.
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Hahn EJ, Hall LA, Rayens MK, Burt AV, Corley D, Sheffel KL. Kindergarten children's knowledge and perceptions of alcohol, tobacco, and other drugs. J Sch Health 2000; 70:51-55. [PMID: 10715825 DOI: 10.1111/j.1746-1561.2000.tb07241.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Kindergarten children's knowledge and perceptions of alcohol, tobacco, and other drugs (ATODs) were assessed and the congruence between parent ATOD use and children's knowledge of ATODs was examined. Data were collected during the pre-intervention phase of an ATOD prevention trial with 5- and 6-year-old children and their parents. Three elementary schools were randomly selected from a population of 15 high-risk elementary schools in Lexington, Ky., (n = 126 parent-child dyads). Children were interviewed about their knowledge, feelings, and attitudes toward ATODs using the Child Drug Awareness Inventory. Parents self-reported ATOD use. Almost all (95%) kindergarten children recognized cigarettes; 56% correctly identified alcoholic beverages; and 17% recognized at least one illicit drug. Minority children were almost four times more likely to recognize illicit drugs than were non-minority children. Children's knowledge of ATODs was not correlated with the parents' reported drug use. ATOD prevention programs for young children merit greater emphasis.
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Affiliation(s)
- E J Hahn
- College of Nursing, University of Kentucky, Lexington 40536-0232, USA.
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Abstract
The purpose of this research was to examine the physical health of rural mothers and their low birth weight children (< 2,500 gm). The health of rural mothers is of concern because rural families have poorer health than urban ones, and as the primary caregiver for the low birth weight child, mother's health affects the child's care and potentially the child's health. In this cross-sectional, exploratory study, in-home interviews were conducted with 48 mothers between 2 weeks and 18 months after their children were discharged from their birth hospitalization. Mothers' physical health and their perceptions of their children's health were assessed. The mothers were more concerned about their children's health than their own (p = .0005). The concerns included uncertainty about the children's future health, growth, and development. Suggestions for community health care providers are addressed.
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Affiliation(s)
- B Sachs
- College of Nursing, University of Kentucky 40536-0232, USA.
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Affiliation(s)
- L A Hall
- Contemporary Medical Archives Centre, Wellcome Library for the History and Understanding of Medicine, University College London
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Abstract
PURPOSE To describe factors influencing the potential for abusive parenting by rural mothers of low-birth-weight children (< 2,500 gm). Low-birth-weight (LBW) children are at risk for child abuse. However, little is known about the added risks created for these children by rural residency. DESIGN Data for this descriptive and exploratory study were collected using a cross-sectional design. A convenience sample of 48 rural mothers delivering LBW children participated in 1994. METHODS In-home interviews were conducted using structured questionnaires to assess mothers' everyday stressors, depressive symptoms, social resources, and child abuse potential. FINDINGS The prevalence of high depressive symptoms among the mothers was 54%. Higher everyday stressors and less functional social support predicted greater depressive symptoms. Everyday stressors had a direct effect on the mothers' potential for child abuse and an indirect effect via maternal depressive symptoms. CONCLUSIONS Rural mothers of LBW children are at risk for abusive parenting. Health care providers should pay particular attention to the mental health of mothers living in rural, isolated areas. Assistance with mobilization of community resources, including social support and child care, may provide needed help for these mothers to improve parenting and thus child health outcomes.
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Affiliation(s)
- B Sachs
- College of Nursing and Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington 40536-0232, USA.
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Carpenter JS, Andrykowski MA, Wilson J, Hall LA, Rayens MK, Sachs B, Cunningham LL. Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale. Issues Ment Health Nurs 1998; 19:481-94. [PMID: 9782864 DOI: 10.1080/016128498248917] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.5] [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: 02/09/2023]
Abstract
The Center for Epidemiologic Studies-Depression Scale (CES-D; L. S. Radloff, 1977) assesses the presence and severity of depressive symptoms occurring over the past week. Although it contains only 20 items, its length may preclude its use in a variety of clinical populations. This study evaluated psychometric properties of 2 shorter forms of the CES-D developed by F. J. Kohout, L. F. Berkman, D. A. Evans, and J. Cornoni-Huntley (1993): the Iowa form and the Boston form. Data were pooled from 832 women representing 6 populations. Internal consistency estimates, correlations with the original version of the CES-D, and omitted-included item correlations supported use of the Iowa form over the Boston form when a shortened version of the scale is desired. Regression statistics are provided for use in estimating scores on the original CES-D when either shortened form is used. Factor analytic results from two populations support a single-factor structure for the original CES-D as well as the short forms.
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Affiliation(s)
- J S Carpenter
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington 40536-0086, USA
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Girard MS, Sirlin CB, Baker KG, Hall LA, Mattrey RF. Liver-tumor detection with ultrasound contrast: a blinded prospective study in rabbits. Acad Radiol 1998; 5 Suppl 1:S189-91; discussion S199. [PMID: 9561078 DOI: 10.1016/s1076-6332(98)80102-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M S Girard
- Department of Radiology, University of California, San Diego Medical Center, USA
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Abstract
BACKGROUND The mechanism by which some victims of childhood abuse become abusive parents, whereas others do not, is not well understood. Previous empirical evidence indicates that social resources may modify the cycle of abuse or maladaptive parenting; however, the effects of different dimensions of social resources have not been compared. OBJECTIVES To determine whether a measure of mothers' potential for physical child abuse was related to their retrospective reports of physical and sexual abuse before 18 years of age and to investigate the potential buffering effects of multiple dimensions of social resources on the relationship between childhood abuse and mothers' potential for physical child abuse. METHODS The potential role of social resources as a moderator of the relationship between a history of childhood abuse and potential for physical child abuse was investigated in 206 low-income single mothers of young children. RESULTS The levels of physical and sexual abuse in childhood were positively associated with the mothers' child abuse potential; sexual abuse displayed the strongest association. Compared with mothers who were not sexually abused in childhood, those reporting violent sexual abuse as children were almost six times more likely to have high potential for physically abusing their children. There was no evidence that any of the social resources modified the relationship of either type of childhood abuse with the mothers' potential for abuse. However, all four dimensions of social resources demonstrated significant main effects on child abuse potential. CONCLUSIONS Low-income mothers face many stressors because of their lack of economic resources. This, coupled with a lack of social resources and a history of childhood abuse, makes low-income, single mothers particularly at risk for abusive parenting. The lives of these women and their children may be enhanced by assisting the women to improve their social resources which, ultimately, may reduce their potential for child abuse. Future research should focus on identifying factors that predict and/or modify the potential for abusive parenting as well as actual abuse.
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Affiliation(s)
- L A Hall
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, USA
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Abstract
BACKGROUND Although recent evidence implies linkages among depression or depressive symptoms, self-esteem, history of childhood abuse, and parenting attitudes, the evidence does not clearly elucidate the relationships among these variables. OBJECTIVES To investigate the relationships among maternal psychosocial factors (history of childhood abuse, everyday stressors, self-esteem, and depressive symptoms) and parenting attitudes of low-income, single mothers who have young children. METHODS Secondary analyses of data from in-home interviews with 206 low-income, single mothers from a southeastern United States urban area were conducted. A variety of scales, including the Adult-Adolescent Parenting Inventory (AAPI), were used to measure maternal psychosocial factors. RESULTS Using the AAPI, a Modified Parenting Attitudes Measure (MPAM), and subscales, a three-stage regression procedure was used to test the model. For stages 1 and 2, everyday stressors were the strongest predictor of self-esteem. Childhood sexual abuse, everyday stressors, low self-esteem, and control variables accounted for 58% of variance in depressive symptoms. In the third stage for the AAPI, only control variables were retained except in the Lack of Empathy subscale, where depressive symptoms and control variables accounted for 16% of the variance. The third stage for the MPAM yielded, by subscale: Only control variables predicted Corporal Punishment Beliefs; depressive symptoms were the strongest predictor for the total MPAM (19% of variance) and of the Inappropriate Emotional Expectations subscale (17%); and childhood physical abuse was the only predictor of Role Reversal. CONCLUSIONS Depressive symptoms mediated the effects of childhood abuse, everyday stressors, and self-esteem and provided the linkage between these variables and at-risk parenting attitudes. Self-esteem decreased as everyday stressors increased but did not directly affect parenting attitudes. A relationship was not found between childhood abuse and low self-esteem. This study highlights the complexity of parenting and the need to identify other factors of at-risk parenting not accounted for in this study.
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Affiliation(s)
- M Lutenbacher
- School of Nursing, Vanderbilt University, Nashville, TN, USA
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Abstract
The effects of a school and home-based drug prevention program on risk factors for subsequent alcohol, tobacco, and other drug (ATOD) use among children were studied. Data on parent and child risk factors for ATOD use were collected from fifty-six low-income parents and their children, ages four to six years, using a pretest-posttest design. The parent-child intervention was conducted over a two-month period. The intervention had no effect on parent or child risk factors. However, the program was favorably received by parents and children. Almost two-thirds of the parents at the experimental school were involved in the program. Almost half of the parents had high depressive symptoms. The high rates of ATOD use and depressive symptoms among these parents are cause for concern.
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Affiliation(s)
- E J Hahn
- University of Kentucky, College of Nursing, Lexington, USA
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Abstract
The nucleotide sequence upstream of the groEL gene of Neisseria gonorrhoeae has been determined. Upstream of groEL is a homolog of groES and the divergently transcribed frpB gene. The promoter region of groES lacks the inverted repeat sequences (IR) that act as a regulatory element controlling the expression of similar operons in many other bacterial species. This region contains overlapping consensus sequences for sigma 32-dependent and sigma 70-dependent promoters, and an appropriately placed transcription start point was mapped downstream of these promoters. Northern hybridization demonstrated that synthesis of a full-length groES-groEL transcript was induced in heat-stressed cells. These experiments also revealed the presence of a shorter groES-specific transcript, apparently the result of the premature termination of transcription at an IR situated between the groES and groEL genes.
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Affiliation(s)
- M Tauschek
- Department of Microbiology, Monash University, Clayton, Victoria, Australia
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Abstract
The purpose of this study was to explore parenting attitudes and behaviors of low-income single mothers with preschool-aged children. As part of a longitudinal study of the health of single-mother families, 44 unstructured and semistructured interviews were conducted over a 1-year period with a subsample of nine mothers. The mothers modelled desired behaviors and values, but held unrealistic expectations for child behaviors. They viewed their parenting responsibilities as overwhelming. The mothers perceived their children as unappreciative of the efforts required to maintain the family unit. Discipline was often punitive and directed toward aversive behaviors with a single child as the scapegoat for parenting frustrations. Implications for interventions are addressed.
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Affiliation(s)
- B Sachs
- College of Nursing, University of Kentucky, Lexington 40536-0232, USA
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Mattrey RF, Baker KG, Hall LA, Steinbach GC, Peterson T. Placental enhancement with AF0145, a perfluorocarbon-stabilized microbubble sonographic contrast agent. Acad Radiol 1996; 3 Suppl 2:S320-1. [PMID: 8796592 DOI: 10.1016/s1076-6332(96)80570-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R F Mattrey
- Department of Radiology, University of California, San Diego 92103, USA
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38
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Abstract
The purpose of this study was to examine the role of self-esteem as a mediator of the effects of stressors and social resources on mothers' postpartum depressive symptoms. Data were collected during in-home interviews with 738 women 1 to 2 months postpartum. Forty-two percent of the women had high depressive symptoms. Self-esteem mediated the effects of everyday stressors and the quality of primary intimate relationships on depressive symptoms. However, everyday stressors also exhibited direct effects. Mothers with low self-esteem were 39 times more likely to have high depressive symptoms than those with high self-esteem. Interventions to decrease postpartum mothers' chronic stressors and to improve the quality of their primary intimate relationships may enhance their self-esteem, which in turn may decrease the likelihood of high depressive symptoms.
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Affiliation(s)
- L A Hall
- College of Nursing, University of Kentucky, Lexington 40536-0232, USA
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39
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Affiliation(s)
- L A Hall
- Contemporary Medical Archives Centre, Wellcome Institute for the History of Medicine, London
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40
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Abstract
The purposes of this study were to describe the psychosocial and environmental contexts affecting the lives of low-income, single mothers and to explore their everyday coping strategies. Nine mothers of preschool children participated in multiple, unstructured and semi-structured in-home interviews. Traumatic childhood experiences including death of a parent and abuse contributed to the mothers' depression and to their coping strategies for survival. The women used creative economic survival strategies such as bartering to meet their families' basic needs. Social isolation, downward social comparison, conflict avoidance, and self-reliance were the emotional self-protective survival strategies used. Strategies to move up economically and emotionally related to the women's desire for a better life for themselves and their families.
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Abstract
The growth of 24 Aspergillus isolates at low oxygen tensions was assessed. Isolates selected included A. fumigatus (10), A. terreus (6), A. niger (6), A. nidulans (1) and A. flavus (1). Three different agar media were used--potato dextrose agar (PDA), pH 5.6; brain heart infusion (BHI), pH 7.4; and a specially developed medium (Hall's) containing resazurin--with oxygen concentrations of 0, 0.025, 0.1, 0.5 and 2.5%. The CO2 concentration was 5%. Agar plates were inoculated with 2 x 10(7) conidia/ml, loaded into jars and flushed with a special gas mixture at 37 degrees C. The plates were inspected at intervals of 3, 5 and 10 days. On Hall's medium, none of the isolates grew at oxygen concentrations of 0 or 0.025%, but 21 (88%) of 24 grew at 0.1%. On PDA and BH1, all 14 isolates tested grew at oxygen concentrations of 0.5 and 2.5%. Three of these 14 conidiated on PDA at oxygen 0.5% and 12 of 14 conidiated on PDA at oxygen 2.5%. None grew without oxygen on these media. Thus, pathogenic Aspergillus spp. are capable of growth at low oxygen tensions, and this may have implications for pathogenicity and antifungal activity.
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Affiliation(s)
- L A Hall
- Department of Medicine, University of Manchester, Hope Hospital, Salford
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Abstract
The purposes of this study were to determine the prevalence of childhood physical and sexual abuse among 206 low-income single mothers and to examine the relationship of childhood abuse to current maternal depressive symptoms. Severe physical abuse was reported by 36 percent of the women. The prevalence of sexual abuse was 22 percent; more than one-half of these women were violently abused. High depressive symptoms were reported by 51 percent of the mothers. Both severe physical abuse and sexual abuse in childhood were associated with high depressive symptoms. Women who experienced violent sexual abuse were almost four and one-half times more likely to report high depressive symptoms, compared to the women who were not sexually abused. These findings provide further evidence that childhood abuse may have long-term consequences for women's mental health.
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Affiliation(s)
- L A Hall
- College of Nursing, University of Kentucky, Lexington 40536-0232
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44
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Affiliation(s)
- L A Hall
- Wellcome Institute for the History of Medicine, London, UK
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45
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Abstract
This pilot study examined the prevalence and correlates of depressive symptoms among community-dwelling elders 75 years of age and older. Forty subjects were recruited from a research volunteer pool. Cross-sectional data were collected during structured in-home interviews. High depressive symptoms were reported by 10 (25%) of the elders; of these, 8 were males. Depressive symptoms were positively related to the need for instrumental support. Higher depressive symptoms were associated with poorer functional health status and self-rated health and with lower morale, life satisfaction, and quality of life. Nurses working with community-dwelling elders 75 years of age or older should be alert for depressive symptoms among those with indications of poor physical and functional health, and instrumental support needs should be assessed. Further investigation into the age/gender issue as it relates to the development of depressive symptoms is warranted.
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Graven SN, Bowen FW, Brooten D, Eaton A, Graven MN, Hack M, Hall LA, Hansen N, Hurt H, Kavalhuna R. The high-risk infant environment. Part 2. The role of caregiving and the social environment. J Perinatol 1992; 12:267-75. [PMID: 1432286] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Neonatal intensive care units are essential for the successful care of very immature and sick infants. The technology of NICUs has contributed significantly to the reduction of neonatal mortality and improvement of neonatal outcome. While the outcome for high-risk neonates has vastly improved over the past three decades, a number of infants sustain injuries and complications that result in long-term disabilities. It is now clear that some of the long-term problems of high-risk infants are a result of the environment and care practices and are not attributable to the original disease or condition that necessitated intensive care. There is accumulating evidence that environmental factors and care practices can interact with disease processes in ways that can increase morbidity, and possibly mortality. In addition to developmental and behavioral problems, there is growing evidence of effects on visual function and perhaps other sensory systems. Many of the environmental and care factors may cause delay in recovery and increase NICU time or unnecessary discomfort, yet not produce long-term disabilities or problems, as currently assessed. Many of the potential behavioral and developmental problems, as well as many of the potential problems with visual, auditory, and other modes of sensory discrimination, are not included in the usual follow-up assessments. The absence of data or the limitations of existing studies are not a cause for comfort or the assumption that the environment and care practices are safe or not harmful.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S N Graven
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa 33612-3805
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Graven SN, Bowen FW, Brooten D, Eaton A, Graven MN, Hack M, Hall LA, Hansen N, Hurt H, Kavalhuna R. The high-risk infant environment. Part 1. The role of the neonatal intensive care unit in the outcome of high-risk infants. J Perinatol 1992; 12:164-72. [PMID: 1522437] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S N Graven
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa 33612-3805
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Hall LA. I can do it myself. Dent Health (London) 1992; 31:10-1. [PMID: 1499777] [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: 12/27/2022]
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Hall LA. Forbidden by God, despised by men: masturbation, medical warnings, moral panic, and manhood in Great Britain, 1850-1950. J Hist Sex 1992; 2:365-387. [PMID: 11623003] [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: 05/23/2023]
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50
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Abstract
The primary purposes of this pilot study were to identify maternal psychosocial correlates of unrealistic expectations of children and of child abuse potential, and to investigate the relationships of these factors with child behavior. A cross-sectional, two-group design was used. One group consisted of 20 low-income mothers whose preschool children were referred to a family care center for suspected abuse or neglect. A comparison group was made up to 20 low-income mothers whose children attended a university-based pediatric clinic and who were not referred for abuse or neglect. Data were collected during structured in-home interviews with the mothers. Measures of parental bonding, maternal depressive symptoms, unrealistic expectations of children, child abuse potential, and child behavior were obtained. Preschool teachers of the children also rated the children's behavior. Mothers with high depressive symptoms reported more unrealistic expectations of children and had greater child abuse potential scores than those with fewer symptoms. The more child behavior problems mothers reported, the greater their unrealistic expectations of the children and the higher their score for child abuse potential. Maternal depressive symptoms were not directly related to child behavior. Teacher reports of child behavior were moderately correlated with maternal reports, but no study variable was associated with teacher reports.
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Affiliation(s)
- B Sachs
- College of Nursing, University of Kentucky, Lexington 40536-0232
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