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Carroll RW, Corley B, Feltham J, Whitfield P, Park W, Howard R, Yssel M, Phillips I, Harper S, Yang J. The value of plasma metanephrine measurements during adrenal vein sampling. Endocr Connect 2024; 13:e230300. [PMID: 38055778 PMCID: PMC10831578 DOI: 10.1530/ec-23-0300] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023]
Abstract
Objective The assessment of primary aldosteronism incorporates adrenal vein sampling (AVS) to lateralize aldosterone excess. Current adrenal vein sampling protocols rely on concurrent cortisol measurements to assess successful cannulation and lateralization and may be inaccurate in the setting of autonomous cortisol secretion. We aimed to compare the measurement of plasma cortisol and metanephrine concentrations to assess cannulation and lateralization during AVS. Design This is a diagnostic accuracy study in a tertiary referral endocrinology department. Methods Forty-one consecutive patients with confirmed primary aldosteronism undergoing AVS (49 procedures) were included. None had cortisol autonomy. The use of plasma metanephrine-based ratios were compared with standard cortisol-based ratios to assess cannulation and lateralization during ACTH-stimulated AVS. Results There was strong agreement between a cortisol selectivity index (SI) ≥5.0 and an adrenal vein (AV) to peripheral vein (PV) plasma metanephrine ratio (AVmet-PVmet) of ≥12.0 to indicate successful cannulation of the AV (n = 117, sensitivity 98%, specificity 89%, positive predictive value (PPV) 95%, negative predictive value (NPV) 94%). There was strong agreement between the standard cortisol-based SI and an AV plasma metanephrine-to-normetanephrine ratio (AVmet-AVnormet) of ≥2.0 to indicate successful cannulation (n = 117, sensitivity 93%, specificity 86%, PPV 94%, NPV 84%). There was strong agreement between the cortisol- or metanephrine-derived lateralization index (LI) > 4.0 for determining lateralization (n = 26, sensitivity 100%, specificity 94.1%, PPV 91.6%, NPV 100%). Conclusions Ratios incorporating plasma metanephrines provide comparable outcomes to standard cortisol-based measurements for interpretation of AVS. Further studies are required to assess the use of metanephrine-derived ratios in the context of confirmed cortisol autonomy. Significance statement Primary aldosteronism is a common cause of secondary hypertension, and adrenal vein sampling remains the gold standard test to assess lateralization. Cortisol-derived ratios to assess cannulation and lateralization may be affected by concurrent cortisol dysfunction, which is not uncommon in the context of primary aldosteronism. Our study showed comparable outcomes when using accepted cortisol-derived or metanephrine-derived ratios to determine cannulation and lateralization during adrenal vein sampling. Further research is required to validate these findings and to assess the use of metanephrine-derived ratios in the context of confirmed concurrent cortisol dysfunction.
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Affiliation(s)
- Richard W Carroll
- Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, New Zealand
| | - Brian Corley
- Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, New Zealand
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Joe Feltham
- Department of Radiology, Wellington Regional Hospital, New Zealand
| | - Patricia Whitfield
- Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, New Zealand
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Rowena Howard
- Diabetes and Endocrinology Service, Hutt Hospital, New Zealand
| | - Melissa Yssel
- Department of Biochemistry & Endocrinology, Awanui Labs, New Zealand
| | - Ian Phillips
- Department of Biochemistry, Awanui Labs, Dunedin, New Zealand
| | - Simon Harper
- Department of Surgery & Anaesethesia, University of Otago, Wellington, New Zealand
- Department of General Surgery, Wellington Regional Hospital, New Zealand
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
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Park W, Whitfield P, Corley B, Harper S, Feltham J, Carroll R. Increasing rates of referrals for investigation of primary aldosteronism at a tertiary centre. N Z Med J 2023; 136:73-84. [PMID: 37956358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
AIM To describe the frequency and characteristics of patients referred for specialist investigation of primary aldosteronism (PA) in the lower North Island over a 5-year period, and the outcomes of those who received treatment. METHODS Patients who underwent confirmatory testing or treatment for PA at Wellington Regional Hospital were retrospectively identified and data were collected from electronic clinical records. RESULTS There has been a five-fold increase in both referrals and confirmatory testing for PA in 2021 compared to 2015. Compared to patients without PA, those eventually diagnosed with PA had a higher ARR, serum sodium, antihypertensive requirement and cardiovascular disease prevalence, as well as lower serum renin, potassium and GFR (all p <0.05), but similar blood pressure. Complete or partial clinical success was achieved in 96% of surgically treated patients compared with 70% of medically treated patients. Thirty-nine percent of patients experienced minor adverse effects with spironolactone and only one significant adverse event was experienced perioperatively. CONCLUSIONS The rate of referrals and confirmatory testing for PA are increasing in our region. Adrenalectomy and mineralocorticoid antagonist therapy are both safe and effective treatments, although minor adverse effects were common with spironolactone.
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Affiliation(s)
| | - Patricia Whitfield
- Consultant Endocrinologist, Endocrine, Diabetes and Research Centre, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, and Department of Medicine, University of Otago, Wellington
| | - Brian Corley
- Consultant Endocrinologist, Endocrine, Diabetes and Research Centre, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, and Department of Medicine, University of Otago, Wellington
| | - Simon Harper
- Endocrine & General Surgeon, Department of General Surgery, Wellington Regional Hospital, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, and Department of Surgery and Anaesthesia, University of Otago, Wellington
| | - Joe Feltham
- Consultant Diagnostic & Interventional Radiologist, Department of Radiology, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley
| | - Richard Carroll
- Consultant Endocrinologist, Endocrine, Diabetes and Research Centre, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, and Department of Medicine, University of Otago, Wellington
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Petrosyan V, Tran C, Whitfield P. 699 Accounting for Fixation Shrinkage in Temporal Artery Biopsy. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
Ascertain the length shrinkage of Temporal Artery Biopsy (TAB) following fixation to inform current practice and ensure samples taken are in keeping with the British Society of Rheumatology Recommendations.
The British Society of Rheumatology (2020) recommends a sample size of at least 1cm post fixation to be of diagnostic value for Giant Cell Arteritis (GCA). Formalin has been shown to cause 20–30% volume shrinkage of histopathological specimens. Shrinkage relating to length, specifically with TABs was shown to be approximately 8% based on a sample size of 13 patients.
Method
A consecutive sample of patients undergoing TAB between January-December 2021 were analysed. Those with measurements documented in the op note were compared to the post fixation measurement documented in the histopathology report. Statistical analysis included demographic data as well p values calculated for the differences in length.
Results
Forty Seven patients were treated for TAB, M:F (1:1.26), Mean Age=73.06 (47–94). Mean pre-fixation length = 26.84mm (SD-8.38), Mean post-fixation length = 20.27mm (SD-8.72). Overall shrinkage was calculated at 25% with a p value of 0.0046, confirming a significant difference between the two sample groups.
Conclusion
This sample demonstrates there to be a clear difference between the two measurements, with a significant percentage shrinkage. Appreciation of shrinkage is vital in obtaining a suitable sample to ensure diagnostic value and appropriate patient care. Further evaluation, both prospective and retrospective is underway with the results pending.
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Affiliation(s)
- V Petrosyan
- York District Hospital , York , United Kingdom
| | - C Tran
- York District Hospital , York , United Kingdom
| | - P Whitfield
- York District Hospital , York , United Kingdom
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Gaffney K, Lucero A, Macartney-Coxson D, Clapham J, Whitfield P, Palmer BR, Wakefield S, Faulkner J, Stoner L, Rowlands DS. Effects of whey protein on skeletal muscle microvascular and mitochondrial plasticity following 10 weeks of exercise training in men with type 2 diabetes. Appl Physiol Nutr Metab 2021; 46:915-924. [PMID: 33591858 DOI: 10.1139/apnm-2020-0943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Skeletal muscle microvascular dysfunction and mitochondrial rarefaction feature in type 2 diabetes mellitus (T2DM) linked to low tissue glucose disposal rate (GDR). Exercise training and milk protein supplementation independently promote microvascular and metabolic plasticity in muscle associated with improved nutrient delivery, but combined effects are unknown. In a randomised-controlled trial, 24 men (55.6 y, SD 5.7) with T2DM ingested whey protein drinks (protein/carbohydrate/fat: 20/10/3 g; WHEY) or placebo (carbohydrate/fat: 30/3 g; CON) before/after 45 mixed-mode intense exercise sessions over 10 weeks, to study effects on insulin-stimulated (hyperinsulinemic clamp) skeletal-muscle microvascular blood flow (mBF) and perfusion (near-infrared spectroscopy), and histological, genetic, and biochemical markers (biopsy) of microvascular and mitochondrial plasticity. WHEY enhanced insulin-stimulated perfusion (WHEY-CON 5.6%; 90% CI -0.1, 11.3), while mBF was not altered (3.5%; -17.5, 24.5); perfusion, but not mBF, associated (regression) with increased GDR. Exercise training increased mitochondrial (range of means: 40%-90%) and lipid density (20%-30%), enzyme activity (20%-70%), capillary:fibre ratio (∼25%), and lowered systolic (∼4%) and diastolic (4%-5%) blood pressure, but without WHEY effects. WHEY dampened PGC1α -2.9% (90% compatibility interval: -5.7, -0.2) and NOS3 -6.4% (-1.4, -0.2) expression, but other messenger RNA (mRNA) were unclear. Skeletal muscle microvascular and mitochondrial exercise adaptations were not accentuated by whey protein ingestion in men with T2DM. ANZCTR Registration Number: ACTRN12614001197628. Novelty: Chronic whey ingestion in T2DM with exercise altered expression of several mitochondrial and angiogenic mRNA. Whey added no additional benefit to muscle microvascular or mitochondrial adaptations to exercise. Insulin-stimulated perfusion increased with whey but was without impact on glucose disposal.
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Affiliation(s)
- Kim Gaffney
- School of Sport, Exercise and Nutrition, Massey University, Wellington and Auckland, New Zealand
| | - Adam Lucero
- School of Sport, Exercise and Nutrition, Massey University, Wellington and Auckland, New Zealand
| | - Donia Macartney-Coxson
- Human Genomics, Institute of Environmental and Scientific Research Ltd (ESR). Porirua, Wellington, New Zealand
| | - Jane Clapham
- Human Genomics, Institute of Environmental and Scientific Research Ltd (ESR). Porirua, Wellington, New Zealand
| | | | - Barry R Palmer
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - StJohn Wakefield
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - James Faulkner
- School of Sport, Health and Community, University of Winchester, Winchester, England
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - David S Rowlands
- School of Sport, Exercise and Nutrition, Massey University, Wellington and Auckland, New Zealand
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Elias M, Wright S, Remenyi J, Abbott J, Edwards S, Gierlinski M, McGrath J, Nicholson W, Paternoster L, Prescott A, Have ST, Whitfield P, Lamond A, Brown S. 197 Functional assessment of the atopic eczema candidate gene EMSY identifies a role in skin barrier formation. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Elias M, Wright S, Remenyi J, Abbott J, Bray S, Cole C, Edwards S, Gierlinski M, Glok M, McGrath J, Nicholson W, Paternoster L, Prescott A, Ten Have S, Whitfield P, Lamond A, Brown S. 326 Enhancer-promoter looping controls EMSY expression, affecting multiple components of skin barrier structure and function with relevance to atopic eczema. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yuen J, Muquit S, Whitfield P. Does open-access provide an opportunity or pose a barrier? A comprehensive survey on the cost of publication in exclusively open-access surgical journals. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gaffney KA, Lucero A, Stoner L, Faulkner J, Whitfield P, Krebs J, Rowlands DS. Nil Whey Protein Effect on Glycemic Control after Intense Mixed-Mode Training in Type 2 Diabetes. Med Sci Sports Exerc 2018; 50:11-17. [PMID: 29251686 DOI: 10.1249/mss.0000000000001404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although intense endurance and resistance exercise training and whey protein supplementation have both been shown to independently improve glycemic control, no known studies have examined the effect of high-intensity mixed-mode interval training (MMIT) and whey supplementation in adults with Type 2 diabetes (T2D). PURPOSE This study aimed to determine if peritraining whey protein supplementation combined with MMIT can improve glycemic control. METHODS In a double-blind, randomized, placebo-controlled trial, 24 men (55.7 ± 5.6 yr) with T2D performed MMIT with whey (20 g) or placebo control for 10 wk. Glycemic control was assessed via glucose disposal rate during a euglycemic insulin clamp, fasting blood glucose concentration, and homeostatic model assessment of insulin resistance. Changes in peak oxygen consumption, 1-repetition maximum strength, vastus lateralis muscle, and subcutaneous adipose thicknesses, and waist circumference were also assessed. RESULTS Ten weeks of MMIT substantially improved glucose disposal rate by 27.5% (90% confidence interval, 1.2%-60.7%) and 24.8% (-5.4% to 64.8%) in the whey and control groups, respectively. There were likely and possible reductions in fasting blood glucose by -17.4% (-30.6% to -1.6%) and homeostatic model assessment of insulin resistance by -14.1% (-25.3% to 1.08%) in the whey group; however, whey effects were not clearly beneficial to glycemic outcomes relative to the control. MMIT also clearly substantially improved 1-repetition maximum by 20.6% (16.3%-24.9%) and 22.7% (18.4%-27.2%), peak oxygen consumption by 22.6% (12.0%-26.2%) and 18.5% (10.5%-27.4%), and vastus lateralis muscle thickness by 18.9% (12.0%-26.2%) and 18.6% (10.5%-27.4%) and possibly reduced waist circumference by -2.1% (-3.1% to -1.0%) and -1.9% (-3.7% to -0.1%) in the control and whey groups, respectively, but the whey-control outcome was trivial or unclear. CONCLUSIONS A clinically meaningful enhancement in glycemic control after 10 wk of MMIT was not clearly advanced with peritraining whey protein supplementation in middle-age men with T2D.
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Affiliation(s)
- Kim Alexander Gaffney
- School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND
| | - Adam Lucero
- School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND
| | - Lee Stoner
- School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND
| | - James Faulkner
- School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND
| | - Patricia Whitfield
- School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND.,School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND
| | - Jeremy Krebs
- School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND.,School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND
| | - David Stephen Rowlands
- School of Sport, Exercise, and Nutrition, Massey University Wellington, Wellington, NEW ZEALAND
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9
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Bergstra TG, Gutmanis I, Byrne J, Faulds C, Whitfield P, McCallum S, Shadd J. Urinary Retention and Medication Utilization on a Palliative Care Unit: A Retrospective Observational Study. J Pain Palliat Care Pharmacother 2018; 31:212-217. [PMID: 29336714 DOI: 10.1080/15360288.2017.1417951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Urinary retention is a common problem at end-of-life that may be a result of medications used to control other symptoms. To determine whether use of retention-causing drugs was associated with catheterization for urinary retention among palliative care unit (PCU) patients, the authors reviewed charts of 91 consecutively admitted patients to a hospital-based PCU. Utilization of eight classes of retention-causing medications (opioids, antidopaminergics, benzodiazepines, anticholinergics, antidepressants, calcium channel antagonists, nonsteroidal anti-inflammatory drugs [NSAIDs], and H1 histamine antagonists) was compared between those catheterized for urinary retention (n = 34) and those never catheterized (n = 31). All patients used medication from more than one class of retention-causing medication. A statistically significant association with urinary retention occurred for antidopaminergic medications, but not other drug classes. The total number of classes of retention-causing medications was not associated with catheterization. These findings question whether urinary retention need hinder medication use for symptom management at end-of-life. Tapering of antidopaminergic medications, compared with other drug classes studied, may be more likely to resolve retention.
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10
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Thompson D, Morrice N, Grant L, Le Sommer S, Ziegler K, Whitfield P, Mody N, Wilson HM, Delibegović M. Myeloid protein tyrosine phosphatase 1B (PTP1B) deficiency protects against atherosclerotic plaque formation in the ApoE -/- mouse model of atherosclerosis with alterations in IL10/AMPKα pathway. Mol Metab 2017; 6:845-853. [PMID: 28752048 PMCID: PMC5518727 DOI: 10.1016/j.molmet.2017.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 12/21/2022] Open
Abstract
Objective Cardiovascular disease (CVD) is the most prevalent cause of mortality among patients with Type 1 or Type 2 diabetes, due to accelerated atherosclerosis. Recent evidence suggests a strong link between atherosclerosis and insulin resistance due to impaired insulin receptor (IR) signaling. Moreover, inflammatory cells, in particular macrophages, play a key role in pathogenesis of atherosclerosis and insulin resistance in humans. We hypothesized that inhibiting the activity of protein tyrosine phosphatase 1B (PTP1B), the major negative regulator of the IR, specifically in macrophages, would have beneficial anti-inflammatory effects and lead to protection against atherosclerosis and CVD. Methods We generated novel macrophage-specific PTP1B knockout mice on atherogenic background (ApoE−/−/LysM-PTP1B). Mice were fed standard or pro-atherogenic diet, and body weight, adiposity (echoMRI), glucose homeostasis, atherosclerotic plaque development, and molecular, biochemical and targeted lipidomic eicosanoid analyses were performed. Results Myeloid-PTP1B knockout mice on atherogenic background (ApoE−/−/LysM-PTP1B) exhibited a striking improvement in glucose homeostasis, decreased circulating lipids and decreased atherosclerotic plaque lesions, in the absence of body weight/adiposity differences. This was associated with enhanced phosphorylation of aortic Akt, AMPKα and increased secretion of circulating anti-inflammatory cytokine interleukin-10 (IL-10) and prostaglandin E2 (PGE2), without measurable alterations in IR phosphorylation, suggesting a direct beneficial effect of myeloid-PTP1B targeting. Conclusions Here we demonstrate that inhibiting the activity of PTP1B specifically in myeloid lineage cells protects against atherosclerotic plaque formation, under atherogenic conditions, in an ApoE−/− mouse model of atherosclerosis. Our findings suggest for the first time that macrophage PTP1B targeting could be a therapeutic target for atherosclerosis treatment and reduction of CVD risk. PTP1B inhibition as therapy for atherosclerosis/cardiovascular disease is proposed. Myeloid-PTP1B mice on ApoE−/− background (ApoE−/−/LysM-PTP1B) were generated. ApoE−/−/LysM-PTP1B had improved glucose homeostasis with no body weight differences. ApoE−/−/LysM-PTP1B had lower lipids and protection against atherosclerotic plaques. Protection was via a PGE2/IL-10/AMPKα mechanism.
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Affiliation(s)
- D Thompson
- Institute of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
| | - N Morrice
- Institute of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - L Grant
- Institute of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - S Le Sommer
- Institute of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - K Ziegler
- Department of Diabetes and Cardiovascular Science, University of the Highlands and Islands, Centre for Health Science, Inverness, UK
| | - P Whitfield
- Department of Diabetes and Cardiovascular Science, University of the Highlands and Islands, Centre for Health Science, Inverness, UK
| | - N Mody
- Institute of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - H M Wilson
- Institute of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - M Delibegović
- Institute of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
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Gutmanis I, Hay M, Shadd J, Byrne J, McCallum S, Bishop K, Whitfield P, Faulds C. Understanding bladder management on a palliative care unit: a grounded theory study. Int J Palliat Nurs 2017; 23:144-151. [PMID: 28345475 DOI: 10.12968/ijpn.2017.23.3.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research regarding factors associated with nursing-initiated changes to bladder management at end-of-life is sparse. OBJECTIVES To explore the process of Palliative Care Unit (PCU) nurses' approach to bladder management changes. METHODS Nursing staff from one PCU in London, Canada were interviewed regarding bladder management care practices. A constructivist grounded theory was generated. RESULTS Four interconnected themes emerged: humanity (compassionate support of patients); journey (making the most of a finite timeline); health condition (illness, functional decline); and context (orders, policies, supplies). These overlapping themes must be considered in light of ongoing changes which prompt recycling through the framework. While bladder management necessitates shared decision-making and individualised care, nurses' phronetic experience may serve to detect the presence of change and the need to consider other alternatives. CONCLUSION End-of-life bladder management requires nurses to continually reconsider the significance of humanity, journey, health condition and context in light of ongoing changes.
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Affiliation(s)
- Iris Gutmanis
- Associate Scientist, Lawson Health Research Institute in London, ON Canada
| | - Melissa Hay
- PhD Candidate, Health and Rehabilitation Sciences, Western University in London, ON Canada
| | - Joshua Shadd
- Assistant Professor, Department of Family Medicine, McMaster University, Hamilton, ON in London, ON Canada
| | - Janette Byrne
- Palliative Pain and Symptom Management Consultation Program, St Joseph's Health Care in London, ON Canada
| | - Sarah McCallum
- Forensic Rehabilitation Unit, St Joseph's Health Care in London, ON Canada
| | - Kristen Bishop
- PhD Candidate, Health and Rehabilitation Sciences, Western University in London, ON Canada
| | - Patricia Whitfield
- Palliative Pain and Symptom Management Consultation Program, St. Joseph's Health Care in London, ON Canada
| | - Cathy Faulds
- Family Physician and Practicing in Palliative Care, Adjunct Professor, Department of Family Medicine, Western University in London, ON Canada
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Rau JG, Wu LS, May AF, Poudel L, Winn B, Garlea VO, Huq A, Whitfield P, Taylor AE, Lumsden MD, Gingras MJP, Christianson AD. Anisotropic Exchange within Decoupled Tetrahedra in the Quantum Breathing Pyrochlore Ba_{3}Yb_{2}Zn_{5}O_{11}. Phys Rev Lett 2016; 116:257204. [PMID: 27391749 DOI: 10.1103/physrevlett.116.257204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Indexed: 06/06/2023]
Abstract
The low energy spin excitation spectrum of the breathing pyrochlore Ba_{3}Yb_{2}Zn_{5}O_{11} has been investigated with inelastic neutron scattering. Several nearly resolution limited modes with no observable dispersion are observed at 250 mK while, at elevated temperatures, transitions between excited levels become visible. To gain deeper insight, a theoretical model of isolated Yb^{3+} tetrahedra parametrized by four anisotropic exchange constants is constructed. The model reproduces the inelastic neutron scattering data, specific heat, and magnetic susceptibility with high fidelity. The fitted exchange parameters reveal a Heisenberg antiferromagnet with a very large Dzyaloshinskii-Moriya interaction. Using this model, we predict the appearance of an unusual octupolar paramagnet at low temperatures and speculate on the development of intertetrahedron correlations.
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Affiliation(s)
- J G Rau
- Department of Physics and Astronomy, University of Waterloo, Ontario N2L 3G1, Canada
| | - L S Wu
- Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A F May
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - L Poudel
- Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - B Winn
- Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - V O Garlea
- Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Huq
- Chemical and Engineering Materials Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - P Whitfield
- Chemical and Engineering Materials Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A E Taylor
- Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - M D Lumsden
- Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - M J P Gingras
- Department of Physics and Astronomy, University of Waterloo, Ontario N2L 3G1, Canada
- Perimeter Institute for Theoretical Physics, Waterloo, Ontario N2L 2Y5, Canada
- Canadian Institute for Advanced Research, 180 Dundas Street West, Suite 1400, Toronto, Ontario M5G 1Z8, Canada
| | - A D Christianson
- Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
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Whitfield P, Parry-Strong A, Walsh E, Weatherall M, Krebs JD. The effect of a cinnamon-, chromium- and magnesium-formulated honey on glycaemic control, weight loss and lipid parameters in type 2 diabetes: an open-label cross-over randomised controlled trial. Eur J Nutr 2015; 55:1123-31. [PMID: 25986159 DOI: 10.1007/s00394-015-0926-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 12/08/2014] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This randomised controlled trial assessed the acute and long-term effects of daily supplementation of kanuka honey, formulated with cinnamon, chromium and magnesium on glucose metabolism, weight and lipid parameters in individuals with type 2 diabetes. METHODS Twelve individuals with type 2 diabetes received 53.5 g of a formulated honey and a control (non-formulated) kanuka honey in a random order for 40 days, using cross-over design. Fasting glucose, insulin, HbA1c, lipids and anthropometric measures were measured at baseline and end of treatment. A meal tolerance test was performed at baseline to assess acute metabolic response. RESULTS There was no statistically significant difference in acute glucose metabolism between treatment groups, as measured by the Matsuda index and AUC for glucose and insulin. After the 40-day intervention with honey, fasting glucose did not differ significantly between the two treatments (95 % CI -2.6 to 0.07). There was no statistically significant change in HbA1c or fasting insulin. There was a statistically significant reduction in total cholesterol by -0.29 mmol/L (95 % CI -0.57 to -0.23), LDL cholesterol by -0.29 mmol/L (95 % CI -0.57 to -0.23) and weight by -2.2 kg (95 % CI -4.2 to -0.1). There was a trend towards increased HDL and reduced systolic blood pressure in the intervention treatment. CONCLUSION The addition of cinnamon, chromium and magnesium supplementation to kanuka honey was not associated with a significant improvement in glucose metabolism or glycaemic control in individuals with type 2 diabetes. Use of the formulated honey was associated with a reduction in weight and improvements in lipid parameters, and should be investigated further.
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Affiliation(s)
- Patricia Whitfield
- Centre for Endocrine, Diabetes and Obesity Research, Wellington Regional Hospital, Wellington, New Zealand.
| | - Amber Parry-Strong
- Centre for Endocrine, Diabetes and Obesity Research, Wellington Regional Hospital, Wellington, New Zealand
| | - Emily Walsh
- Centre for Endocrine, Diabetes and Obesity Research, Wellington Regional Hospital, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jeremy D Krebs
- Centre for Endocrine, Diabetes and Obesity Research, Wellington Regional Hospital, Wellington, New Zealand.,Department of Medicine, University of Otago, Wellington, New Zealand
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Dorward D, Lucas C, Doherty M, Chapman G, Scholefield E, Conway-Morris A, Kipari T, Robb C, Felton J, Whitfield P, Haslett C, Dhaliwal K, Rossi A. P20 Delineating The Contribution Of Formylated Peptides And Formyl Peptide Receptor 1 To The Pathogenesis Of Acute Lung Injury. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Gutmanis I, Shadd J, Woolmore-Goodwin S, Whitfield P, Byrne J, Faulds C. Prevalence and indications for bladder catheterization on a palliative care unit: a prospective, observational study. Palliat Med 2014; 28:1239-40. [PMID: 25398521 DOI: 10.1177/0269216314536090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Iris Gutmanis
- Evaluation and Research, Specialized Geriatric Services, St. Joseph's Health Care London, Parkwood Hospital, London, ON, Canada Department of Epidemiology and Biostatistics, Western University, London, ON, Canada Lawson Health Research Institute, London, ON, Canada
| | - Joshua Shadd
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, ON, Canada
| | | | | | - Janette Byrne
- Palliative Pain & Symptom Management Consultation Program, St. Joseph's Health Care London, Parkwood Hospital, London, ON, Canada
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16
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Murng SHK, Follows L, Whitfield P, Snowden JA, Swallow K, Green K, Sargur R, Egner W. Defining the impact of individual sample variability on routine immunoassay of serum free light chains (sFLC) in multiple myeloma. Clin Exp Immunol 2013; 171:201-9. [PMID: 23286947 DOI: 10.1111/cei.12011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/27/2022] Open
Abstract
Serum free light chain (sFLC) measurement has gained widespread acceptance and is incorporated into various diagnostic and response criteria. Non-linearity and antigen excess are the main causes of 'variability' in the measurement of sFLC using immunoassay, but the impact of these on measurement has been unclear. We performed a retrospective evaluation using a dilutional strategy to detect these phenomena. A total of 464 samples in 2009 and 373 samples in 2010 were analysed for sFLC. Non-linearity was detected in both high and apparently normal sFLC. Major non-linearity of more than twofold is common in high kappa (20·2%) and lambda (14·1%). It is less common in samples with apparently normal levels - kappa (6·4%) and lambda (9·5%). 9·4% of kappa and 15·5% of lambda showed antigen excess at screening dilutions. 34·4% of the samples had either non-linearity or antigen excess. We conclude that significant measurement variability is common in the measurement of sFLC. There is currently no reliable technique to detect non-linearity phenomena unless a serial dilution strategy is applied to every analysis. We recommend that laboratories routinely reporting sFLC results for clinical services need appropriate strategies for addressing these issues. Clinicians should be aware of these limitations in interpretation of sFLC assay for individual patients. Future guidelines should adopt action thresholds which are grounded firmly in test performance parameters.
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Affiliation(s)
- S H K Murng
- Immunology Department, Northern General Hospital, Sheffield, UK
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17
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18
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Abstract
BACKGROUND The variations in the anatomy of the external branch of the superior laryngeal nerve (EBSLN) are generally classified according to the relationship of the nerve to the superior thyroid artery, or the superior pole of the thyroid. Both artery and superior pole are themselves variable landmarks, and therefore are not consistent between subjects. We sought to examine EBSLN anatomy in relation to alternate, more consistent surgical landmarks. METHODS Fifteen hemi-larynges from 20 embalmed human cadavers were dissected anatomically. Each nerve was categorized using established classification systems, and terminal branching patterns were also noted. Nerve location was recorded in relation to three different constant anatomical structures: the laryngeal prominence, midline junction of the cricothyroid muscles and ipsilateral cricothyroid joint. RESULTS All cadavers were of European descent. The EBSLN had two branches to the cricothyroid muscle in 34% of cases. The EBSLN anatomical types found were mainly Cernea type 1 (80%), with 7% type 2a and 13% type Ni. An EBSLN was more likely to lie in an 'at risk' location if the subject was less than 160 cm tall. The EBSLN entered the crico-thyroid muscle at a median distance of 14 mm lateral from the laryngeal prominence and 8 mm inferiorly. The median distance from the medial-most point of the cricothyroid muscle junction was 14 mm laterally and 14 mm superiorly, and from the cricothyroid joint the entry lay a median distance of 10 mm superiorly and 11 mm medially. CONCLUSIONS The variability of EBSLN anatomy is again evident, as is the need for careful and knowledgeable surgical technique. New surgical landmarks for the relations of the insertion of the EBSLN reveal a deployment range for each, but one of more of these landmarks may prove useful in thyroid surgery.
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Affiliation(s)
- Patricia Whitfield
- Department of Otolaryngology-Head and Neck Surgery, Manukau, New Zealand
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19
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Singh R, Whitfield P. 55 Antibiotic prophylaxis in the management of compound mandibular fractures requiring ORIF: a two stage prospective audit. Br J Oral Maxillofac Surg 2010. [DOI: 10.1016/s0266-4356(10)60056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Abstract
The anatomical course of the external branch of the superior laryngeal nerve (EBSLN) is variable, and a consistent approach to its preservation during thyroid surgery is needed to reduce risk of post-operative voice impairment. Despite agreement that careful dissection in the region of the superior thyroid pole is required, there is no accepted 'best' approach, nor any universal acknowledgement that location of the EBSLN is actually necessary. The popular cernea classification of EBSLN has limitations, including its decreased reliability with increased thyroid size and its irrelevance in cases of 'buried' variants. * Recent work has identified factors such as ethnicity and stature in the prevalence of EBSLN variants. Consistent approaches to the post-operative detection of EBSLN injury are needed to build an accurate picture of the incidence of surgical nerve injury. Then a standardised approach to EBSLN preservation may emerge.
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Affiliation(s)
- R P Morton
- Department of Otorhinolaryngology, Head and Neck Surgery SAMC, Manukau City, Auckland, New Zealand.
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Whitfield P, Johnson AW, Dunn KA, Delauche AJ, Winchester BG, Franklin RJ. GM1-gangliosidosis in a cross-bred dog confirmed by detection of GM1-ganglioside using electrospray ionisation-tandem mass spectrometry. Acta Neuropathol 2000; 100:409-14. [PMID: 10985700 DOI: 10.1007/s004010000187] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The post-mortem diagnosis of lysosomal storage diseases can be confounded by the unavailability of suitable material. Here we report the diagnosis of GM1-gangliosidosis in a cross-bred dog, from which only formalin-fixed brain was available, by a combination of electron microscopy and the detection of elevated levels of GM1-ganglioside within the tissue using the novel technique of electrospray ionisation tandem mass spectrometry. Electron microscopic examination of ultrathin sections of resin-embedded tissue revealed cytoplasmic inclusions (membranous cytoplasmic and zebra bodies) in brain stem and cerebellar neurons that were characteristic of a gangliosidosis. Glycolipids were extracted from the fixed tissue and analysed by tandem mass spectrometry. Two major ions were detected, which corresponded to GM1 (d18:1-C18:0) and Gm1 (d20:1-C18:0). Their identity was confirmed by comparison of their fragmentation patterns with those of authentic standards. The concentration of GM1 was approximately sixfold higher on a wet weight basis than in the brain of a normal control dog, confirming the diagnosis of GM1-gangliosidosis.
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Affiliation(s)
- P Whitfield
- Biochemistry, Endocrinology and Metabolism Unit, Institute of Child Health, University College London, UK
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Abstract
Long-term parenteral nutrition of infants who have had major gut resections is associated with a high incidence of cholestatic liver disease. Affected infants have high plasma concentrations of phytosterols--compounds that resemble cholesterol but have an alkylated side chain. The phytosterols that accumulate in patients receiving parenteral nutrition are derived from the soya oil and/or soya lecithin used to make the intravenous lipid emulsion. There is a striking association between phytosterolemia and cholestatic liver disease. This has led us to put forward the hypothesis that phytosterols can cause cholestasis in susceptible infants. Experiments using neonatal piglets indicate that phytosterols (given without any of the other components of parenteral nutrition) can indeed reduce bile flow. We suggest that increasing the content of phytosterols in cell membranes may interfere with the function of important transport proteins involved in the secretion of bile. Other factors that might contribute to cholestasis (such as inhibition of cholesterol 7 alpha-hydroxylase) are discussed.
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Affiliation(s)
- P T Clayton
- Biochemistry Unit, Institute of Child Health, London, United Kingdom
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Wakefield J, Whitfield P. Preventing and defending lawsuits against elder-care facilities. Med Interface 1996; 9:89-90, 110. [PMID: 10163862] [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: 02/11/2023]
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25
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Whitfield P. The Shunt Book. J Neurol Psychiatry 1995. [DOI: 10.1136/jnnp.59.5.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Whitfield P, Guazzo E. ICP reduction following decompressive craniectomy. Stroke 1995; 26:1125-6. [PMID: 7762036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Antonakopoulos GN, Turton J, Whitfield P, Newman J. Host-parasite interface of the urinary bladder-inhabiting nematode Trichosomoides crassicauda: changes induced in the urothelium of infected rats. Int J Parasitol 1991; 21:187-93. [PMID: 1869353 DOI: 10.1016/0020-7519(91)90009-v] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The urinary bladders of rats infected with Trichosomoides crassicauda were studied by light, scanning and transmission electron microscopy. The bladder epithelium of infected rats showed a diffuse, mild, flat hyperplasia, four to six cells thick. The anterior parts of adult female worms were embedded in tunnels within the hyperplastic epithelium with the posterior portions of the parasites lying free in the bladder lumen. The hyperplastic epithelial cells forming the inner layer of the tunnel wall, adjacent to the parasite, showed degenerative changes. These cells contained single or multiple pycnotic nuclei. Their cytoplasm was fibro-granular in appearance, with few distinct organelles, and the luminal surfaces of the cells were not limited by plasma membranes. Small numbers of granular cells, similar in appearance to mast cells, were seen in, and possibly crossing, the epithelium. There was no infection-related increase in the number or type of inflammatory cells in the lamina propria. Questions of interest emerging from this study relate to the nutrition of an adult nematode occupying an intra-epithelial location, and the absence of a significant chronic inflammatory response to the mature worm. It is suggested that the avascular hyperplastic epithelium of the bladder is an immunologically 'protected site' for the mature female T. crassicauda.
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Abstract
This study confirms that women requesting breast reduction and breast augmentation differ beyond the anatomical. There were significantly more single and co-habiting women in the breast reduction group, and significantly more separated and divorced women in the breast augmentation group, compared to women attending an obstetric clinic. The majority of women requesting surgery agreed that to feel more confident was an important reason for seeking surgery, but those requesting breast augmentation also stressed the need to feel more feminine and less shy with men. A significantly higher percentage of the breast augmentation group had been pregnant, and they had a higher average number of pregnancies than the obstetric comparison group, together with a significantly higher experience of miscarriage. The psychodynamic proposal that women requesting breast augmentation are seeking to symbolically boost their sense of femininity and womanliness is supported by this study.
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Affiliation(s)
- S Birtchnell
- Academic Department of Psychiatry, St George's Hospital, London, U.K
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Danesh BJ, Burke M, Newman J, Aylott A, Whitfield P, Cotton PB. Comparison of weight, depth, and diagnostic adequacy of specimens obtained with 16 different biopsy forceps designed for upper gastrointestinal endoscopy. Gut 1985; 26:227-31. [PMID: 3972269 PMCID: PMC1432632 DOI: 10.1136/gut.26.3.227] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The influence of endoscopic forceps variables (size, design, and make) on biopsy specimen weight, depth, and diagnostic adequacy has been studied in vitro on normal human stomach, and in vivo at endoscopy in dog and in patients. Greater pressure during the biopsy procedure yielded significantly heavier, deeper, and histologically more acceptable specimens. Standard sized forceps (diameter 2.4 mm) and those with ellipsoid cups consistently produced larger specimens than the smaller 'paediatric' forceps (1.8 mm) and those with round cups. Deeper specimens were also obtained using the standard forceps. In vitro and in vivo in the dog, the standard sized forceps also produced specimens of greater diagnostic adequacy than the paediatric forceps. At endoscopy in patients, however, we could not detect any influence of the size, shape, and presence of forceps spike or fenestration on the diagnostic adequacy of the specimens.
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Whitfield P. Clinical medical officers in a child health service. Br Med J 1979; 1:612. [PMID: 427464 PMCID: PMC1598377 DOI: 10.1136/bmj.1.6163.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Volkers C, Cooke B, Bennett C, Byrom N, Campbell M, Elliot P, Whitfield P. The significance of urinary melanoma antigen excretion and the ability of thymosin to raise the level of depleted lymphocytes in vitro in malignant melanoma. Aust N Z J Surg 1978; 48:32-6. [PMID: 307381 DOI: 10.1111/j.1445-2197.1978.tb05801.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
One hundred and fifty-six patients were screened for the presence of urinary melanoma antigen and serum cytoplasmic antibody. It was found that 44% of symptomless Stage 1 patients tested five to 15 years after operation had detectable antigen (Ag) in their urine; the urines of 67% of Stage 2A (local recurrence) patients were positive for Ag; while in only 38% of those patients graded 2B (lymph-node involvement) were these tests positive. Urines of 83% of patients with generalized metastases (Stage 3) were positive. A sequential study was made of 23 patients seen and treated in 1976. Of this group, 14 reverted from a positive state to a negative one following excision of their tumour, while six were negative on first postoperative testing and subsequently became positive. Three out of the 23 remained persistently negative. T lymphocyte levels were assessed in 71 melanoma patients, and a stage-related fall was noticed. Thymosin (Hoffman LaRoche) on in vitro incubation significantly raised the levels of T lymphocytes.
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Abstract
Insulin-stimulated gastric secretion alone, without reference to basal secretion, has been examined in 45 male patients with duodenal ulcer in whom no gastric operation had been performed and in 124 patients following vagotomy for duodenal ulcer. Gastric juice was examined in terms not only of conventional indices, observed volume, titratable acidity and acid output, but also Vg, the volume corrected for pyloric loss and duodenal reflux. The range of secretion of the unoperated subjects was established in terms of peak and half-totwo-hour values for all indices. By reference to these ranges, secretion of postvagotomy subjects could be divided into two groups: (a) those with secretion within the preperative range, and (b) those with secretion less than the lower limit of the preoperative range. The best discrimination was given by Vg; those within the preoperative range (peak Vg in excess of 140 ml/hour and Vg half to two hours in excess of 105 ml/hour) had a 50% liability to recurrent ulcer, while those below the preoperative range had a zero liability to recurrent ulcer. Of the conventional indices acid output gave the best discrimination, which was almost as good as Vg. Peak acid output of 8 mmol/hour or acid output one half to two hours of 525 mmol/hour discriminated into two groups, with a 50% or zero liability to recurrent ulcer. Titratable acidity (Hollander's index of secretion), being highly susceptible to reflux, was not an adequate discriminant.
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Abstract
Insulin-stimulated secretion has been studied in 67 subjects with intact vagi. The relationship between the changes in the concentrations of hydrogen and sodium ions in individual 10-minute samples showed a highly significant negative correlation. In quantitative terms, this correlation could be explained by the mixing of isotonic gastric juice and duodenal reflux but not by back-diffusion. In 37 subjects duodenal juice was labelled with either bromsulphalein (BSP) or indocyanine green (ICG), both dyes being excreted only in the bile. In aspirated gastric juice there were highly significant positive correlations between the concentration of the dye and the concentration of duodenal reflux calculated from a formula based on the output of sodium ions. The volume of duodenal reflux occurring during insulin-stimulated secretion was estimated from the sodium output in normal controls, in preoperative patients with duodenal ulcer, and in patients following vagotomy with or without a drainage procedure. Reflux following gastrojejunostomy greatly exceeded that occurring in all other groups. Reflux following vagotomy with no drainage procedure was less than that in preoperative patients, and in patients in whom pyloroplasty or gastrojejunostomy had been performed.
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Faber RG, Russell RC, Parkin JV, Whitfield P, Hobsley M. Proceedings: The predictive accuracy of the insulin test after vagotomy: a new interpretation. Gut 1974; 15:347-8. [PMID: 4834591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Fiddian-Green RG, Whitfield P, Russell RC, Faber RG, Hobsley M. Proceedings: Indocyanine green as a marker of duodenal reflux in aspirated gastric juice. Br J Surg 1974; 61:323-4. [PMID: 4832658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Hobsley M, Hassan MA, Cameron A, Faber RG, Whitfield P. Proceedings: Duodenal ulcer and maximal gastric secretion. Br J Surg 1974; 61:328-9. [PMID: 4832669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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37
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Battle RJ, Whitfield P. The significance of the prealveolar cleft in assessing a prognosis in future maxillary development. Cleft Palate J 1970; 7:397-401. [PMID: 5270485] [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: 01/14/2023]
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