Biomedical subjects

C Thomas

Publications and source records attributed to C Thomas.

At least 19 recordsLinked to original sources

PubMed2006

Immunization information systems progress - United States, 2005.

Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS). This report summarizes data from CDC's 2005 Immunization Information System Annual Report (IISAR), a survey of grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. These data indicated that approximately 56% of U.S. children aged <6 years participated in an IIS, an increase from 48% in 2004. Moreover, 75% percent of public vaccination provider sites and 44% of private vaccination provider sites submitted vaccination data to an IIS during July-December 2005. These findings underscore the need to increase the number of participating children, from the current 13 million to approximately 21 million, to assure 95% participation of children aged <6 years and improve the effectiveness of U.S. immunization programs.

Child, Preschool↗

PubMed2006

Surfactant era (1990-2002) 2-year outcomes of infants less than 1500 g from a Community Level 3 Neonatal Intensive Care Unit.

OBJECTIVE: To report Bayley scores of 572 twenty-four-month corrected age infants whose birth weights (BWs) were less than 1500 g cared for in a Community Level 3 Neonatal Intensive Care Unit (NICU) between 1990 and 2002 when surfactant was routinely used. STUDY DESIGN: Survival, "normal" defined as both Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI)>84, MDI>69 and MDI>84 were analyzed by gestational age (GA) and BW. Comparisons were made between infants born pre- and post-1996 when high-frequency oscillatory ventilation came into frequent use, Medicaid and non-Medicaid infants, multiples and singletons, outborn and inborn infants, boys and girls and infants with intrauterine growth retardation (IUGR) and those appropriate for gestational age (AGA). RESULTS: There was a correlation between GA and BW and improving outcomes. Scores do not approach those of normal standardization sample populations (60% for "normal", 68% for MDI>84 and 95% for MDI>69) until 1400 g and 30 weeks. Medicaid, outborn and IUGR infants, and boys did worse in some aspects. CONCLUSION: There was a correlation between both GA and BW and improving outcomes. Availability of these developmental data on a laminated pocket card can facilitate presentation of outcome experience to families by pediatric and obstetric caregivers.

Child Development↗

PubMed2006

Cholesterol dependent downregulation of mouse and human apical sodium dependent bile acid transporter (ASBT) gene expression: molecular mechanism and physiological consequences.

BACKGROUND AND AIMS: Faecal bile acid elimination greatly contributes to cholesterol homeostasis. Synthesised from cholesterol in the liver, bile acids are actively reclaimed in the ileum by the apical sodium dependent bile acid transporter (ASBT). Although the expression level of ASBT affects body cholesterol balance, the impact of cholesterol on ASBT gene expression remains unclear. In this study, the effect of cholesterol on ASBT expression and ileal bile acid uptake was explored in vivo and in vitro. METHODS: ASBT gene expression was assessed by real time quantitative polymerase chain reaction and northern or western blotting, or both, in mice subjected to a 2% cholesterol diet for two weeks, in mouse ileal explants, or in human enterocyte-like Caco-2 cells cultured in sterol enriched or depleted media. Bile acid uptake was determined by measuring [3H]-taurocholic acid influx into in situ isolated ileal loops from mice or into differentiated Caco-2 cells. Molecular analysis of mouse and human ASBT promoters was undertaken with reporter assays, site directed mutagenesis, and electrophoretic mobility shift assays. RESULTS: In mice, cholesterol enriched diet triggered a downregulation of ASBT expression (mRNA and protein), a fall in ileal bile acid uptake, and a rise in the faecal excretion of bile acids. This effect was direct as it was reproduced ex vivo using mouse ileal explants and in vitro in differentiated Caco-2 cells. CONCLUSIONS: This regulation, which involves an original partnership between SREBP-2 and HNF-1alpha transcription factors, affects ileal bile acid recycling and thus might participate in the maintenance of body cholesterol homeostasis.

Animals↗

PubMed2006

Vascular and Alzheimer-type pathology in an autopsy study of African-Americans.

The authors studied 13 autopsy brains from a larger cohort of 270 African-Americans with a clinical diagnosis of Alzheimer disease (AD), vascular dementia (VaD), or stroke without dementia. Two subjects exhibited changes of pure VaD, 5 had pure AD, and 6 showed a mixture of AD pathology and strokes. Overall, there was good agreement between the pathologic diagnoses and the clinical diagnoses.

Black or African American↗

PubMed2006

Radiation dose reduction to breast and thyroid during MDCT: effectiveness of an in-plane bismuth shield.

PURPOSE: To evaluate dose reduction and image deterioration using in-plane bismuth breast-shielding and thyroid-shielding for MDCT. MATERIAL AND METHODS: Skin and organ doses of thyroid and breast were measured with thermoluminescent dosimeters in a female Alderson-Rando Phantom with and without a 4-ply in-plane bismuth shield. Routine neck (120 kVp, 150 mAs(eff); 16 x 1.5 mm) and chest (120 kVp, 100 mAs(eff); 16 x 1.5 mm) scan protocols were simulated on a 16-row MDCT scanner in three different settings: without shielding, with the shield directly on the surface, and with a 1-cm-thick cotton spacer between surface and shield. Image noise was quantified and compared using the t test. RESULTS: On average, shielding resulted in a 47% organ-dose reduction for the thyroid and 32% for the breast. Placement of the spacer between shield and surface had no significant impact on the measured doses, but significantly decreased the image noise (P < 0.05). CONCLUSION: In-plane bismuth breast and thyroid shielding significantly decreases radiation dose in MDCT without deteriorating image quality.

Artifacts↗

PubMed2006

The role of trans-oral digital pressure in the removal of large dumbbell shaped tumor from deep lobe of parotid gland.

A 44-year-old male patient, a cardiothoracic surgeon by profession, presented with a tumor arising from the deep lobe of the right parotid gland. Investigations confirmed its para-pharyngeal location and its dumbbell shape. A total conservative parotidectomy was performed preserving full function of the facial nerve. The case is presented because of the unique technique used for this procedure.

Adenoma, Pleomorphic↗

PubMed2006

Phase I/II study of vaccination with dendritic-like leukaemia cells for the immunotherapy of acute myeloid leukaemia.

Twenty-two patients with acute myeloid leukaemia were recruited into a phase I/II clinical trial investigating the vaccination of patients in complete remission (CR) with autologous dendritic-like leukaemia cells (DLLC). At trial entry, leukaemia cells were harvested and tested for their ability to undergo cytokine-induced dendritic cell differentiation. Patients were then treated with intensive chemotherapy. Five patients achieved both CR and had leukaemia cells that successfully underwent differentiation and therefore proceeded to vaccination. Four escalating doses of DLLC were administered weekly by subcutaneous injection. Vaccination was generally well tolerated although one patient developed extensive eczema and an increased antinuclear factor titre possibly indicating induction of autoimmunity. Development of anti-leukaemic T-cell responses was assessed by enzyme-linked immunospot analysis of gamma-interferon secreting T lymphocytes and by human leucocyte antigen tetramer analysis for WT1-specific T cells. Increases in anti-leukaemic T-cell responses were demonstrated in four patients, but only two of the five remained in remission more than 12 months postvaccination. The study has demonstrated that generation of DLLC is feasible in only a subgroup of patients and is currently neither broadly applicable or clinically effective.

Acute Disease↗

PubMed2006

Making sense of dying: a review of narratives written since 1950 by people facing death from cancer and other diseases.

UNLABELLED: This article reviews a sample of narratives written since 1950 by people knowingly facing death as a result of cancer and other diseases, in order to compare experiences and show how these relate to wider changes in practice in end of life care. METHODS: A bibliographic search of libraries, archives, journals and internet sources located English spoken literature, including books, poems, newspapers, journal articles, diaries, and internet postings of writings by people facing terminal disease. Bibliometric and qualitative content analysis explored changing authorship, experiences, purpose in writing, and reported the impact on readers. RESULTS: The initial search located a wide range of published and unpublished narratives, to which inclusion/exclusion criteria were applied, yielding 148 narratives by different authors since 1950. A purposive sub-sample of 63 of these narratives was reviewed. DISCUSSION: Over the last half century there have been changes in both the volume of available literature and patterns of writing about end of life experience. Therapeutic benefits of writing are reported as a way of making sense of dying combined with a strong sense of purpose in sharing the story. There is a clear awareness of social needs when dying, along with issues of communication with medical staff, symptom control, realities of suffering, and spiritual aspects of dying. Differences are found in the nature and style of writing about cancer in comparison to other illnesses.

Attitude to Death↗

PubMed2006

Preimplantation genetic diagnosis: development and regulation.

Pre-implantation genetic diagnosis (PGD) is used to biopsy and analyse embryos created through in vitro fertilisation (IVF) to avoid implanting an embryo affected by a mutation or chromosomal abnormality associated with serious illness. It reduces the chance that the parents will be faced with a difficult decision of whether to terminate the pregnancy, if the disorder is detected during the course of gestation. PGD is widely accepted for this purpose although there have been suggestions that such procedures have the effect of de-valuing persons in the community with disabilities. PGD potentially has other more controversial purposes, including the selection of the sex of the baby for personal preferences such as balancing the family, rather than to avoid a sex-linked disorder. Recently PGD has become available to create a donor child who is Human Leukocyte Antigen (HLA) matched with a sibling in need of stem cell transplant. In most cases the intention is to utilise the cord blood. However, an HLA-matched child could potentially be required to be a donor of tissues and organs throughout life. This may arise should the initial cord blood donation fail for any one of several reasons, such as inadequate cord blood cell dose, graft failure after cord blood transplant, or the recipient child experiencing a recurrence of the original illness after transplant. However, such on-going demands could also arise if a HLA-matched child was fortuitously conceived by natural means. As such, the issue is not PGD, but rather whether to harvest bone marrow or a solid organ from a child. This raises the question of whether there should be limits and procedures to protect such children from exploitation until they achieve sufficient competence to be able to make mature and autonomous decisions about whether to donate, even if the consequence may in some cases be that it is too late to save the sibling. Additionally, the parents may not be able to make a dispassionate decision, when they have a conflict of interests between their children. As such, parents may not be the best proxy decision-makers in this area and the decision might be better made by an independent authority or court. This paper considers ethical and legal issues arising from PGD. It will compare the willingness of the HFEA in the United Kingdom to allow this process to be used even in cases where the condition suffered by the sibling is non-heritable, with the more restrictive guidelines in New Zealand and questions the constitutional basis on which ethics committees develop policy in the absence of a legislative framework.

Ethics Committees↗

PubMed2005

[Molecular genetics of cardiac arrhythmias].

INTRODUCTION: Recent progress in molecular biology led to the identification of the genes involved in various cardiac arrhythmias causing syncope and sudden death in young people. EXEGESIS: This article briefly describes the clinical features and the genes associated with the congenital long QT syndrome, the short QT syndrome, Brugada's syndrome, catecholaminergic polymorphic ventricular tachycardias and arrhythmogenic right ventricular dysplasia. CONCLUSION: Identification of genetic variations that cause cardiac tachyarrhythmias can help to identify at risk-patients and to propose clinical follow-up and preventive therapy. Further studies are needed to discover other cardiac genetic disorders and to understand cellular mechanisms involved in these diseases.

Arrhythmias, Cardiac↗

PubMed2005

Haemochromatosis protein is expressed on the terminal web of enterocytes in proximal small intestine of the rat.

The haemochromatosis protein (HFE) is an important regulator of body iron stores. In the liver, HFE is required for appropriate expression of hepcidin, a humoral mediator of iron absorption. HFE is also present in enterocytes, though its function in the intestine is unknown; it is not intrinsically required for iron absorption, but can augment iron absorption when over-expressed-independent of hepcidin regulation by the liver. In this study, an antibody was raised against rat HFE and validated by enzyme-linked immunosorbent assay, Western blot and quenching of antibody function by the immunising peptide. The sub-cellular location of HFE in enterocytes of iron-deficient and control rats was determined by double-labelling experiments with markers for the microvillus membrane, terminal web, early endosomes, lysosomes and the transferrin receptor. Parallel studies were performed for the primary iron absorption protein, divalent metal transporter 1 (DMT1). HFE co-localised exclusively with the terminal web of intestinal enterocytes. HFE expression was increased in iron deficiency, consistent with a second regulatory role for HFE in iron absorption, independent of hepcidin from the liver. DMT1 was localised primarily on the microvillus membrane, but did partially co-localise with HFE raising the possibility that the two proteins may interact to regulate iron absorption.

Animals↗

PubMed2005

The validation of simple scoring methods for evaluating compartment-specific synovitis detected by MRI in knee osteoarthritis.

OBJECTIVES: Synovitis is common in osteoarthritis (OA) of the knee. In order to evaluate its importance, valid and reliable quantification methods are required. The aim of this study was to compare simple, semiquantitative synovitis scores with detailed volume assessments in subjects with knee OA using magnetic resonance imaging (MRI) as the investigative tool. METHODS: Thirty-five subjects with clinically diagnosed OA of the knee were assessed for synovitis using gadolinium-enhanced MRI. The volume measurement of synovitis was assessed at four sites (medial and lateral parapatellar recesses, intercondylar notch and suprapatellar pouch). The semiquantitative scoring of synovitis was scored on a 0-3 scale. Establishment of a correlative relationship was undertaken using Spearman's rho for the individual site-specific measurements. Ordinal regression modelling was undertaken in order to establish the capacity of the synovitis scoring to predict the volume measurement. RESULTS: A total of 140 sites were assessed. There were good correlations between the semiquantitative scores and the volume measurements, ranging from rho = 0.86 (P < 0.00) for the medial parapatellar recess to rho = 0.71 (P < 0.00) for the lateral parapatellar recess. The ordinal regression suggested that, while the synovitis scores predicted between 50 and 70% (R2 = 0.53, P < 0.00 to R2 = 0.71, P < 0.00) of the volume measurements, there was some minor overlap, particularly in the mid-range synovitis scores. CONCLUSIONS: These results suggest that semiquantitative synovitis scores are valid and will enable feasible evaluation of the synovium in OA cohorts.

Aged↗

PubMed2005

Hydrogen adsorption on graphite (0001) surface: a combined spectroscopy-density-functional-theory study.

The adsorption of H/D atoms on the graphite (0001) surface is investigated by means of both high-resolution electron-energy loss spectroscopy (HREELS) and periodic first-principle density-functional theory. The two methods converge towards two modes of adsorption: adsorption in clusters of about four hydrogen atoms and adsorption in pairs of atoms on contiguous carbon sites. The desorption energies estimated from the calculated dissociation energies range from 8 to 185 kJ mol(-1) leading to an estimated surface coverage at saturations of 30-44 at. %. These results are compared with previous thermal desorption spectroscopy results. New HREEL signal assignments are proposed based on quantum calculations.

Journal Article↗

PubMed2005

[Evaluation of a new E-test method for antimicrobial sensitivity testing of Pseudomonas aeruginosa isolates from cystic fibrosis].

BACKGROUND: Sputum bacteriological analysis of cystic fibrosis (CF) patients colonised by Pseudomonas aeruginosa is difficult. The bronchial persistence of these bacteria involves phenotypical modifications and the many antibiotic treatments result in emergence of multiresistant strains. The aim of this study is to evaluate a new fast identification and sensitivity testing method of P. aeruginosa and other pathogenic bacteria in sputum of CF patients. It is based on applying a gradient of antibiotic (E-test strip) onto an agar plate inoculated with the sputum. OBSERVATIONS: 310 sputum, collected from adults and children colonised by P. aeruginosa, were analysed by this new method. This method allowed a direct reading of the minimal concentration of antibiotic that inhibited the totality of Gram-negative strains and the detection of resistant pathogenic bacteria inside the ellipse of inhibition. Results obtained by this new method were compared with the conventional method for identification and antimicrobial sensitivity. CONCLUSION: This new method, studying with CF patient colonised by P. aeruginosa, appears interesting, with a sensibility equal or higher than 89% in detection of the bacteria and their sensitivity to antibiotics. Furthermore it allows a saving of time and simplified results.

Adult↗

PubMed2005

The gene encoding the human ileal bile acid-binding protein (I-BABP) is regulated by peroxisome proliferator-activated receptors.

Peroxisome proliferator-activator receptors (PPAR) are involved in cholesterol homeostasis through the regulation of bile acids synthesis, composition, and reclamation. As ileal bile acid-binding protein (I-BABP) is thought to play a crucial role in the enterohepatic circulation of bile acids, we investigated whether I-BABP gene expression could also be affected by PPAR. Indeed, treatment with the PPARalpha-PPARbeta/delta agonist bezafibrate led to the up-regulation of I-BABP mRNA levels in the human intestine-derived Caco-2 cells. Cotransfections of the reporter-linked human I-BABP promoter (hI-BABP-2769/+44) together with PPAR and RXR expression vectors demonstrated that the fibrate-mediated induction of the I-BABP gene is dependent on PPARalpha or PPARbeta/delta. Using progressive 5' deletions of the hI-BABP promoter and sequence analysis, we identified a putative PPAR-binding site located at the position -198 and -186 upstream of the transcription initiation site. Electrophoretic mobility shift assays showed that the PPAR/RXR heterodimer can specifically bind to this PPRE-like motif. The deletion of the PPRE within the hI-BABP promoter abolished the PPAR-mediated transactivation in transient transfection assays. The regulation of the I-BABP promoter by PPAR appears species-specific, as the mouse I-BABP promoter, which lacks a conserved PPRE, was not responsive to exogenous PPAR expression in the presence of bezafibrate. Our findings show that the I-BABP gene may be a novel target for PPAR in humans and further emphasize the role for PPAR in the control of bile acid homeostasis.

Animals↗

PubMed2005

Multi-centre pilot study of 2-chlorodeoxyadenosine and cytosine arabinoside combined chemotherapy in refractory Langerhans cell histiocytosis with haematological dysfunction.

The aim of this study was to assess the efficacy and adverse effects of 2-chlorodeoxyadenosine (2-CdA) and cytosine arabinoside (Ara-C) in children with refractory Langerhans cell histiocytosis (LCH) and haematopoietic dysfunction. Ten patients, with a median age at diagnosis of 0.5 years, were enrolled in this study. Treatment comprised at least two courses of Ara-C (1000 mg/m(2)/d) and 2-CdA (9 mg/m(2)/d) administered for 5d every 4 weeks; subsequent median follow-up was 2.8 years (range 0.03-6.4 years). Among the 7 patients who received at least two courses of therapy, disease activity decreased in 6 patients, and control of disease was achieved in all patients after a median delay of 5.5 months. All patients suffered World Health Organisation (WHO) grade 4 haematological toxicity. Two septic deaths occurred shortly after administration of the first course of 2-CdA/Ara-C; a third patient was withdrawn from the trial after the first course and subsequently died following haematopoietic stem cell transplantation. This series is small, but we conclude that 2-CdA and Ara-C combined chemotherapy probably has major activity in childhood refractory Langerhans cell histiocytosis.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2005

["FRAGILE"-Old people and surgery].

As life expectancy and modern surgical and intensive care techniques develop, the number of old patients in surgery is rising. Associated are problems with the indication for surgical intervention and rising incidence of "typical" peri- and postoperative complications such as postoperative delirium. Geriatric assessment serves to identify patients at risk of developing complications, to describe the postoperative course of functional and cognitive abilities, and to adjust therapeutic strategies to the individual needs of these patients. The most important instruments of geriatric assessment are described. Postoperative delirium, the most prevalent complication in surgical geriatric patients, is discussed in detail with regard to risk factors, prevalence, diagnosis, and therapeutic options.

Activities of Daily Living↗

PubMed2005

[An unusual cause of pulmonary cysts].

INTRODUCTION: Multiple pathologies may be associated with cystic appearances in the lungs. Lymphangioleiomyomatosis, Langerhans cell histiocytosis and lymphocytic interstitial pneumonia are the principal causes of thin walled pulmonary cysts. CASE REPORT: We report the case of a non-smoking woman of 71 years, a retired farmer, who was admitted on account of cough, increasing dyspnoea, fever and loss of weight that developed following exposure to hay. The thoracic CT scan revealed diffuse ground glass opacities and centrilobular nodules. Multiple thin walled cystic shadows were distributed homogeneously throughout both lung fields. Broncho-alveolar lavage revealed a marked lymphocytosis (63%) and precipitins for Microsporum Faeni were strongly positive (6 arcs). The respiratory symptoms resolved spontaneously during the stay in hospital, allowing the patient to be discharged after 3 weeks with the advice to avoid all contact with hay. One month later she remained symptom free, the repeat CT scan showed a diminution ofthe ground glass opacities and the nodules but persistence of the pulmonary cysts. CONCLUSION: The diagnosis of hypersensitivity pneumonitis should be considered in the presence of a diffuse pulmonary infiltrate with multiple thin walled cysts in a patient with a suggestive history and clinical picture.

Aged↗