Long term outcomes in children with trichohepatoenteric syndrome

Trichohepatoenteric syndrome (THES) is a rare autosomal recessive disorder caused by mutations in either TTC37 or SKIV2L, usually leading to congenital diarrhea as part of a multisystem disease. Here, we report on the natural history of the disease for the largest UK cohort of patients with THES from 1996 to 2020. We systematically reviewed the clinical records and pathological specimens of patients diagnosed with THES managed in a single tertiary pediatric gastroenterology unit. Between 1996 and 2020, 13 patients (7 female and 6 male) were diagnosed with THES either by mutation analysis or by clinical phenotype. Two patients died from complications of infection. All patients received parenteral nutrition (PN) of which six patients were weaned off PN. All patients had gastrointestinal tract inflammation on endoscopy. Almost half of the cohort were diagnosed with monogenic inflammatory bowel disease (IBD) by the age of 11 years, confirmed by endoscopic and histological findings. Protracted diarrhea causing intestinal failure improves with time in all patients with THES, but monogenic IBD develops in later childhood that is refractory to conventional IBD treatments. Respiratory issues contribute to significant morbidity and mortality, and good respiratory care is crucial to prevent comorbidity.

Atmospheric CH4 oxidation by Arctic permafrost and mineral cryosols as a function of water saturation and temperature

The response of methanotrophic bacteria capable of oxidizing atmospheric CH₄ to climate warming is poorly understood, especially for those present in Arctic mineral cryosols. The atmospheric CH₄ oxidation rates were measured in microcosms incubated at 4 °C and 10 °C along a 1-m depth profile and over a range of water saturation conditions for mineral cryosols containing type I and type II methanotrophs from Axel Heiberg Island (AHI), Nunavut, Canada. The cryosols exhibited net consumption of ~2 ppmv CH₄ under all conditions, including during anaerobic incubations. Methane oxidation rates increased with temperature and decreased with increasing water saturation and depth, exhibiting the highest rates at 10 °C and 33% saturation at 5 cm depth (260 ± 60 pmol CH₄ gdw^-1 d^-1 ). Extrapolation of the CH₄ oxidation rates to the field yields net CH₄ uptake fluxes ranging from 11 to 73 μmol CH₄  m^-2 d^-1 , which are comparable to field measurements. Stable isotope mass balance indicates ~50% of the oxidized CH₄ is incorporated into the biomass regardless of temperature or saturation. Future atmospheric CH₄ uptake rates at AHI with increasing temperatures will be determined by the interplay of increasing CH₄ oxidation rates vs. water saturation and the depth to the water table during summer thaw.

Introduction of sodium pentosan polysulfate and avoidance of urethral catheterisation: improved outcomes in children with haemorrhagic cystitis post stem cell transplant/chemotherapy

PURPOSE

Haemorrhagic cystitis (HC) is an uncommon but potentially devastating complication of chemotherapy and bone marrow transplantation in children. We aimed to test the hypothesis that early recognition, sodium pentosan polysulfate (SPP), and avoidance of urethral catheterisation improve outcomes in children with HC.

METHODS

A retrospective case note review was performed of all patients treated for HC in our hospital from 2002 to 2010. A protocol for the management of HC was introduced in 2007 advocating early detection, use of SPP, and avoidance of urethral catheterisation. Data collected on each patient included primary condition, medications at onset, blood transfusions, duration of symptoms, catheter usage, and outcome. Statistical analysis was performed using the Mann-Whitney U test, and Fisher's Exact test as appropriate, P < .05 being significant.

RESULTS

Five patients were treated using protocol with 5 historical controls. There was no significant difference between the ages of the group, diagnosis, and treatment at onset of HC. In the historical group, 4 of 5 died with HC, but all recovered in the protocol group (P < .05). Blood transfusion requirements were also significantly reduced after protocol introduction (P < .05).

CONCLUSION

Early identification, avoidance of urethral catheterisation, and use of SPP significantly reduces blood transfusion requirements and mortality from HC.

Alterations in the post-translational modification and intracellular trafficking of clusterin in MCF-7 cells during apoptosis

Clusterin is a heterodimeric, disulfide-linked 70-80 kDa glycoprotein that is induced during regression of most, if not all, hormone-dependent epithelial tissues. These studies describe the biogenesis and intracellular trafficking of clusterin in MCF-7 cells before and after the initiation of apoptosis with antiestrogens and TNF alpha. Under physiological conditions, clusterin is modified in the endoplasmic reticulum (ER), and proteolytically cleaved in the Golgi to generate discrete alpha and beta chains prior to secretion. Treatment with TNFalpha or the antiestrogen, ICI 182,780, induces apoptosis in MCF-7 cells and leads to substantial changes in the activity of Golgi-resident enzymes, significantly altering the biogenesis of clusterin. This leads to the appearance of a 50-53 kDa uncleaved, nonglycosylated, disulfide-linked isoform of clusterin that accumulates in the nucleus. While clusterin contains a cryptic SV-40-like nuclear localization signal, mutation of this sequence does not affect the nuclear accumulation of the disulfide-linked nuclear isoform. Confocal microscopy demonstrates that the nuclear accumulation of clusterin is coincident with DNA fragmentation. These data suggest that, at least in secretory epithelial cells, retrograde transport from the Golgi to the ER of a nonglycosylated, uncleaved isoform and the subsequent translocation of clusterin to the nucleus occur in dying cells.

Working With a Multidisciplinary Team in Secure Psychiatric Environments

1. Research on working with a multidisciplinary team in inpatient mental health care is underdeveloped. 2. Knowledge of how to work as part of a team is taken for granted within the realm of professional training. 3. In effective teams, members value the support, knowledge, and professional development that membership offers. 4. Training teams to be more effective requires diverse educational strategies.

Quality of life measures in a high security environment

In 1995, Rampton Hospital was designated as the national centre for people with learning disabilities requiring secure care. Since then, the nursing research unit at Rampton Hospital has examined quality of care and patient satisfaction with some of this client group (Fisher 1994, Robinson 1996, Robinson and Reed 1996). This article reports the findings of an exploratory study to measure the quality of life for people with learning disabilities based on a study carried out at the Elwyn Community Learning Disability Unit in the United States.

Polish and British nurses' responses to patient need

This research study explored the differences between the responses of a cohort of British nurses and a cohort of Polish nurses to a patient's expression of need. Using a vignette to elicit the responses, the study showed that the cohorts gave similar responses in terms of cheering the patient up, offering explanation and showing warmth. Differences were demonstrated in relation to collecting information, giving advice and suggestions, and referring the patient to the doctor. Both cohorts, however, rarely gave responses which demonstrated empathy. The authors conclude that better training in therapeutic communication is needed.

Evidence-based care through clinical practice

This article describes how a working group examined ways to overcome difficulties with applying research findings to clinical practice. The group developed a ward-based distance learning package to assist in developing staff skills and ultimately enhance patient health care. The package has implications for all registered nurses in all nursing contexts.

Forensic nursing: a review of concepts and definitions

This article considers the evidence for the existence of forensic nursing as a sub-specialty in mental health care. Using definitions and concepts described in nursing literature from the UK and the US, the author argues that forensic nursing as a distinctive branch of nursing does not in fact exist.

Coagulation and fibrinolytic profile of paediatric patients undergoing cardiopulmonary bypass

The haemostatic system and the use of heparin during cardiopulmonary bypass (CPB) have been studied extensively in adults but not in children. Results from adult trials cannot be extrapolated to children because of age-dependent physiologic differences in haemostasis. We studied 22 consecutive paediatric patients who underwent CPB at The Hospital for Sick Children, Toronto. Fibrinogen, factors II, V, VII, VIII, IX, XII, prekallikrein, protein C, protein S, antithrombin (AT), heparin cofactor II, alpha 2-macroglobulin, plasminogen, alpha 2-antiplasmin, tissue plasminogen activator (tPA), plasminogen activator inhibitor, thrombin-AT complexes (TAT), D-dimer, heparin (by both anti-factor Xa assay and protamine titration) and activated clotting time (ACT) were assayed perioperatively. The timing of the sampling was: pre heparin, post heparin, after initiation of CPB, during hypothermia, post hypothermia, post protamine reversal and 24 h post CPB. Plasma concentrations of all haemostatic proteins decreased by an average of 56% immediately following the initiation of CPB due to haemodilution. During CPB, the majority of procoagulants, inhibitors and some components of the fibrinolytic system (plasminogen, alpha 2 AP) remained stable. However, plasma concentrations of TAT and D-dimers increased during CPB showing that significant activation of the coagulation and fibrinolytic systems occurred. Mechanisms responsible for the activation of haemostasis are likely complex. However, low plasma concentrations of heparin (< 2.0 units/ml in 45% of patients) during CPB were likely a major contributing etiology. ACT values showed a poor correlation (r = 0.38) with heparin concentrations likely due to concurrent haemodilution of haemostatic factors, activation of haemostatic system, hypothermia and activation of platelets. In conclusion, CPB in paediatric patients causes global decreases of components of the coagulation and fibrinolytic systems, primarily by haemodilution and secondarily by consumption.

A study of nurses' knowledge of the UKCC code of conduct

This study investigated nurses' and midwives' knowledge of the Code of Professional Conduct (UKCC 1992). Knowledge was assumed to be dependent on practitioners' abilities to identify correctly authentic statements and to discriminate against statements which were constructed as distracters. Generally, there was a relatively high mean of correct identification. Certain spheres of responsibility were more likely to be identified than others. These areas involved statements that were practitioner-centred and occurred early in the code. The authors recommend further research into nurses' understanding of the code.

Nurse teachers must improve their academic background and skills

I read with interest the Castledine column ‘Future standards for teaching in nursing’ (Vol 3 (6): 297-8) which reflected the UKCC's current position on standards of teaching and proposed recommendations for its improvement (UKCC, 1994). It suggests that the Council is going to require nurse teachers to have relevant and up-to-date clinical experience to enable them to teach students of nursing. While such a requirement appears to be based on a great deal of commonsense, the conventional wisdom of this approach needs to be challenged because it may in fact be based on erroneous assumptions about the nature of nursing and nurse education.

Effects of two "lipid-lowering" diets on plasma lipid levels of patients with peripheral vascular disease

Fifty subjects with peripheral vascular disease were randomly assigned to either the American Heart Association Hyperlipidemia Diet C (AHA, N = 23) or a higher fiber, low fat diet based on the Pritikin maintenance diet (HFD, N = 27) and studied for a 12-month period. Diet counseling was provided, and the subjects were encouraged to exercise regularly, to decrease their consumption of salt, alcohol, and caffeine, and to restrict cigarettes as much as possible. Dietary intake data showed that energy distribution was approximately 49% and 64% carbohydrate, 20% and 22% protein, and 31% and 14% fat for the AHA and HFD groups, respectively. Cholesterol and dietary fiber intakes averaged 201 mg and 23 gm per day, respectively, for the AHA group and 108 mg and 43 gm per day, respectively, for the HFD group. Generally, both groups showed tendencies toward decreased serum triglycerides, cholesterol, and LDL cholesterol and increased HDL cholesterol. The HFD group achieved a significant decrease in serum cholesterol (at month 12) (p less than .01). The only significant between-group difference was in serum cholesterol at 4 months (p less than .01), with the lower value in the HFD group. There was a consistent negative correlation between dietary fiber and serum cholesterol levels (p less than .01). Average weight loss was 4.1 kg for the AHA group and 6 kg for the HFD group. We concluded that both dietary regimens, combined with exercise, can be of benefit to patients with peripheral vascular disease.

Effects of dietary manipulation on vascular status of patients with peripheral vascular disease

In a one-year, double-blind clinical trial, 45 patients with peripheral vascular disease (PVD) were randomly assigned to either the American Heart Association Hyperlipidemia Diet C (n = 20) or a low-fat, high-fiber, complex carbohydrate diet similar to the Pritikin Maintenance Diet (n = 25). Vascular status and blood lipid levels were monitored at 0, 2, 4, 6, and 12 months. Walking distance increased significantly in both groups, with no difference between groups. No vascular parameters changed significantly, suggesting that increased walking distance was due to improved metabolic capacity of the muscle. A trend toward lower blood lipid values was observed, with no significant differences within or between groups. We conclude that while patients with PVD benefit from a program of diet and exercise, there is no apparent advantage to the more difficult complex carbohydrate diet.