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Biomedical subjects

S Bottoms

Publications and source records attributed to S Bottoms.

15 recordsLinked to original sources
PubMed2006

Facial motor function monitored by hand held calipers versus computer-assisted photography.

BACKGROUND: It is essential to have easy to use, reliable tools to assess and compare facial function for clinical records, audit and research purposes. In this study, two different techniques were examined, Hand held calipers (HHC, as described by Burres), and computerised analysis of digital photographs (CAOP) using Adobe Photoshop 7. The aim of this study was to determine the level of agreement between two operators (physiotherapist) using HHC to measure the distance between facial landmarks, and the level of agreement between two operators (photographers) using CAOP to measure the same distance between facial landmarks and explore whether these two techniques can be used interchangeably. METHOD: The distance between facial landmarks was measured, with the face at rest and following four standard facial expressions. All measurements were repeated one week later to permit inter/intra-rater reliability over time to be assessed. Nine female volunteers with normal facial function were included in the study. RESULTS: The intra- and inter-rater agreement using CAOP was high whereas the agreement was low when using HHC. CONCLUSION: Hand held calipers proved to be an unreliable technique for monitoring facial function. However digital photography when combined with Adobe Photoshop 7 provides a highly reliable objective measurement tool. It was simple to use, low cost and suitable for use in a clinical environment.

Adult↗
PubMed2000

The preterm prediction study: cervical lactoferrin concentration, other markers of lower genital tract infection, and preterm birth. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

OBJECTIVE: This study was undertaken to determine the relationship among cervical lactoferrin concentration, other cervical markers potentially related to infection, and spontaneous preterm birth. STUDY DESIGN: Cervical lactoferrin concentrations obtained at 22 to 24 weeks' gestation among 121 women who had a spontaneous preterm birth <35 weeks' gestation were compared with cervical lactoferrin concentrations among 121 women matched for race, parity, and center who were delivered at >/=37 weeks' gestation. Results were compared against levels of cervical interleukin 6, fetal fibronectin, and sialidase, against cervical length according to ultrasonography, and according to the bacterial vaginosis Gram stain score. RESULTS: Cervical lactoferrin concentrations ranged from not measurable (19% of the concentrations were below the threshold for this assay) to a titer of >/=1:64. There was no significant difference in the overall distributions of lactoferrin concentrations between the case patients and control subjects (P =.18). Only when the highest titers of lactoferrin were considered were there more women in the spontaneous preterm birth group (6/121 vs 0/121; P =.03). According to Spearman correlation analyses the cervical lactoferrin concentrations were strongly related to interleukin 6 concentration (r =.51; P =.0001), sialidase activity (r =.38; P =.0001), and bacterial vaginosis (r =.38; P =.0001), were weakly related to fetal fibronectin (r =. 16; P =.01), and were not related to cervical length. With the 90th percentile (a dilution of 1:32) used as a cutoff to establish a dichotomous variable, lactoferrin concentration had the following odds ratios and 95% confidence intervals for associations with other potential markers of infection: bacterial vaginosis odds ratio, 4.8 (95% confidence interval, 2.2-10.3); interleukin 6 concentration odds ratio, 2.8 (95% confidence interval, 1.2-6.5); sialidase activity odds ratio, 5. 5 (95% confidence interval, 2.2-13.7); fetal fibronectin concentration odds ratio, 0.6 (95% confidence interval, 0.2-2.0); chlamydiosis odds ratio, 2.3 (95% confidence interval, 0.8-6.9); and short cervix odds ratio, 0.5 (95% confidence interval, 0.2-1.4). CONCLUSIONS: Lactoferrin found in the cervix correlated well with other markers of lower genital tract infection. High lactoferrin levels were associated with spontaneous preterm birth but had a very low predictive sensitivity.

Bacterial Infections↗
PubMed1996

The preterm prediction study: risk factors in twin gestations. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

OBJECTIVE: Our purpose was to determine the association between the presence of bacterial vaginosis, fetal fibronectin, and a short cervix and the risk of spontaneous preterm birth of twins. STUDY DESIGN: We prospectively screened 147 women with twins at 24 and 28 weeks' gestation for more than 50 potential risk factors for spontaneous preterm birth. We also measured cervical length with ultrasound scans and tested for the presence of bacterial vaginosis. Fetal fibronectin level was evaluated every 2 weeks from 24 to 30 weeks' gestation. Outcomes included spontaneous preterm birth at < 32 weeks, < 35 weeks, and < 37 weeks. RESULTS: Among twin as compared with singleton pregnancies, a cervical length < or = 25 mm was more common at both 24 and 28 weeks, a statistically significant difference. There were no significant differences in most other risk factors. Of the factors evaluated by means of univariate analysis at 24 weeks, only a short cervix (< or = 25 mm) was consistently associated with spontaneous preterm birth. The odds ratio and 95% confidence interval for spontaneous preterm birth at < 32 weeks, < 35 weeks, and < 37 weeks were 6.9 (2.0 to 24.2), 3.2 (1.3 to 7.9), and 2.8 (1.1 to 7.7). At 28 weeks, a cervical length < or = 25 mm was not a strong predictor of spontaneous preterm birth. At both 28 weeks (odds ratio, 9.4; confidence interval, 1.0 to 67.7) and 30 weeks (odds ratio 46.1; confidence interval, 4.2 to 1381), a positive fetal fibronectin result was significantly associated with spontaneous preterm birth at < 32 weeks. Bacterial vaginosis at 24 or 28 weeks was not associated with spontaneous preterm birth of twins. Multivariate analysis confirmed the association between cervical length < or = 25 mm at the 24-week visit and spontaneous preterm birth and also confirmed that at 24 weeks the other risk factors were less consistently and often not statistically significantly associated with spontaneous preterm birth. Of the risk factors evaluated at 28 weeks, only a positive fetal fibronectin was associated with a significantly increased risk for spontaneous preterm birth. CONCLUSIONS: Most known risk factors for spontaneous preterm birth were not significantly associated with spontaneous preterm birth of twins. At 24 weeks, cervical length < or = 25 mm was the best predictor of spontaneous preterm birth at < 32 weeks, < 35 weeks, and < 37 weeks. Of the risk factors evaluated at 28 weeks, fetal fibronectin was the only statistically significant predictor of spontaneous preterm birth at < 32 weeks.

Adolescent↗
PubMed1995

Delivery of the premature infant.

Significantly preterm delivery should ideally occur in centers with neonatal intensive care units and be attended by pediatric staff. The progress of labor, fetal heart rate patterns, and indications of fetal compromise differ substantially from those seen at term. Steroids and antibiotics are frequently indicated; research is focused on the use of phenobarbital, magnesium sulfate, and thyrotropin-releasing hormone. Selective use of episiotomy may be beneficial. The suggestion that cesarean delivery before the onset of labor reduces intraventricular hemorrhage in very low birth weight infants has not been demonstrated clearly. Vertical uterine incision is frequently needed for cesarean delivery of very low birth weight infants. Cesarean delivery is usually employed for very low birth weight infants in breech presentation or if either fetus in a twin gestation is not in vertex presentation, but is usually not needed for face or compound vertex presentations. Ultrasound examination should be performed to identify major malformations associated with preterm delivery. Serious morbidity is uncommon after 32 weeks' gestation; mortality and disability are concentrated in those with birth weights less than 1,000 grams. In the latter group, the decision of whether to intervene for fetal indications should be considered as soon as it appears delivery is likely. This decision should be based on early pregnancy dating, when available. In the absence of reliable dates, ultrasound measurements of biparietal diameter and femur length are more reliable than estimated fetal weight.

Delivery, Obstetric↗
PubMed1995

Time-course of antigen-induced airway inflammation in the guinea-pig and its relationship to airway hyperresponsiveness.

The causative relationship between airway inflammation and hyperreactivity is unclear, since inflammatory changes have been examined at one or, at most, a few time-points after antigen challenge in both human asthma and animal models. We have made a detailed investigation of inflammatory and functional changes in the airways up to 8 days after antigen challenge in guinea-pigs. In particular, we examined the hypothesis that eosinophil-derived mediators contribute to tissue damage and the development of airway hyperresponsiveness. Following antigen challenge, the influx of inflammatory cells and mediator release in airway tissue and bronchoalveolar lavage fluid were correlated temporally with histopathological changes in airway tissue and airway responsiveness. Eosinophil influx was demonstrable at 4 h. Eosinophilia peaked after 24 h and persisted for at least 8 days. Parallel increases in the concentrations of major basic protein and eosinophil cationic protein in bronchoalveolar lavage fluid indicated that the eosinophils were activated. Eosinophilia was accompanied by subepithelial oedema and epithelial damage co-localized with major basic protein immunoreactivity. A transient neutrophilia (< 48 h duration) and an increase in neutrophil elastase in bronchoalveolar lavage fluid peaked at 14 h. The proportion of airway macrophages with an activated morphology increased at 8 h and remained markedly elevated until 72 h. Airways were hyperresponsive to histamine at 4 h and for at least 8 days. The antigen-induced airway inflammation resemble in time-course and histopathology that seen in antigen-challenged asthmatics, and indicate that the eosinophil and its cytotoxic proteins may be major mediators of airway mucosal damage and airway hyperresponsiveness.

Aluminum Hydroxide↗
PubMed1994

Screening for pregnancy risk-drinking.

The efficacy of alcohol screening questionnaires, the TWEAK, T-ACE, NET, MAST, and CAGE, in detecting periconceptional risk-drinking, > or = 1 oz absolute alcohol/day, was investigated in 4743 African-American women attending an inner-city prenatal clinic who had reported ever drinking. Sensitivity, specificity, positive predictive value, efficiency, follow-up rates, and receiver operating characteristics of the questionnaires were examined to compare the overall effectiveness of the questionnaires and their performance at cut-points defining positive scores ranging from 1 to 3. Relatively little difference between TWEAK, T-ACE, and MAST was seen in the receiver operating characteristic accuracy indices; NET and CAGE lagged behind. Sensitivity/specificity scores for the two questionnaires most sensitive at cut-point 1 were TWEAK (87/72) and T-ACE (83/75). At cut-point 2, sensitivity was optimized with respect to specificity; TWEAK (79/83) was significantly more sensitive than T-ACE (70/85; p = 0.002). At cut-point 3, the two most sensitive tests were MAST (61/92) and TWEAK (59/94). In general, measures of merit were not greatly affected by the time between conception and the administration of the screens. Screening was most sensitive for women interviewed during the first 15 weeks of pregnancy; risk-drinkers tended to delay entry into prenatal care, increasing positive predictive values associated with screening later in pregnancy. This study confirms the utility, when screening for risk-drinking during pregnancy, of brief questionnaires that assess alcohol intake indirectly by asking women about their tolerance to alcohol's effects, psychological consequences of drinking, and significant others' concern about their drinking. It validates T-ACE and provides preliminary data indicating that TWEAK may outperform T-ACE.

Adolescent↗
PubMed1993

Thrombosis and hormone replacement therapy in postmenopausal women.

OBJECTIVE: The effects of postmenopausal hormone replacement therapy on thrombosis remain controversial. We tested the hypothesis that estrogen or progesterone has no significant effect on thrombosis by means of newly developed markers of blood clotting, specifically prothrombin fragment 1 + 2, a marker of factor Xa generation, and thrombin-antithrombin III complex, a marker of thrombin generation. STUDY DESIGN: A prospective study that included 106 women, 68 postmenopausal women on hormone replacement therapy and 38 postmenopausal controls, was performed. Plasma levels of prothrombin fragment 1 + 2 and thrombin-antithrombin III complex were measured by enzyme-linked immunosorbent assay. Multivariate analysis of the covariance was used for statistical analysis, controlling for patient's age because the hormone replacement therapy group was older. RESULTS: There were no statistically significant differences between the hormone replacement therapy and control groups in either of the clotting parameters measured. A comparison of the levels of prothrombin fragment 1 + 2 and thrombin-antithrombin III complex in patients receiving estrogen alone or estrogen plus progestin also revealed no differences. CONCLUSIONS: Current doses of postmenopausal hormone replacement therapy do not appear to enhance in vivo clotting. Thromboembolic complications among postmenopausal women receiving hormone replacement therapy may therefore be secondary to congenital or other acquired coagulation defects.

Adult↗
PubMed1990

Changes in hemostasis activity during delivery and the immediate postpartum period.

Postpartum deep vein thrombosis is believed to be related to increased activation of the hemostasis system at the time of delivery. To date, studies designed to test this hypothesis have had relatively small sample sizes or used the measurement of specific coagulation factors and functional tests reflecting hemostasis activity in vitro. With the use of recent technologic advances we determined the effect of delivery on hemostasis in vivo by measuring 11 hemostatic indices simultaneously in 70 healthy pregnant women. Significant increases were found in fibrinopeptide A (p less than 0.001), beta-thromboglobulin (p less than 0.001), and platelet factor 4 (p less than 0.001), suggesting maximum platelet activation and fibrin formation at the time of delivery. In addition to continued clotting activity at 3 hours post partum, increased D-dimer, fibrin-fibrinogen degradation products, and decreased alpha 2-antiplasmin levels suggest maximum fibrinolysis. These changes reflect a peak in hemostatic activity at delivery and in the immediate postpartum period that may predispose the development of deep vein thrombosis.

Adult↗
PubMed1990

Increased intravascular coagulation associated with pregnancy.

Based on an increased turnover of the hemostatic system, it is believed that pregnancy is associated with "hypercoagulability." However, this hypothesis is based primarily on the measurement of specific coagulation factors or functional tests reflecting hemostatic activity in vitro. Using recent technological advances, we determined the effect of pregnancy on hemostasis in vivo by measuring 11 specific hemostatic indices simultaneously in 28 healthy pregnant women and in 24 nonpregnant female controls. Significant increases were found in fibrinopeptide A (P less than .01), beta thromboglobulin (P less than .001), platelet factor 4 (P less than .02), and fibrin(ogen) degradation products (P less than .001), suggesting increased platelet turnover, clotting, and fibrinolysis. This state of compensated, accelerated intravascular coagulation may be necessary for maintenance of the uterine-placental interface and preparation for the hemostatic challenge of delivery.

Adult↗
PubMed1989

Cordocentesis in the diagnosis of intrauterine starvation.

Glycine and valine were measured in umbilical venous blood obtained by cordocentesis from 28 small-for-gestational-age fetuses. The values were compared with those from 62 appropriate-for-gestational-age fetuses. The ratio of glycine to valine was higher in the small-for-gestational-age fetuses and correlated significantly with the degree of fetal hypoxemia. These findings indicate that placental insufficiency is associated with a biochemical disturbance in the fetus that is similar to that observed in children with protein deprivation and kwashiorkor syndrome.

Blood Specimen Collection↗
PubMed1989

Effect of chronic maternal drug addiction on placental drug metabolism.

Microsomes were prepared from the term placentas of 5 drug-dependent and 4 normal (control) mothers and from the livers of 3 normal fetuses (gestational age = 22-24 weeks) to determine if chronic maternal drug addiction can induce metabolic pathways in the placenta which are utilized in the biotransformation of drugs of abuse. Using as model substrates aminopyrine for demethylation, aniline for hydroxylation, and bilirubin for conjugation, we observed little to none of substrate biotransformation in both drug-dependent and control placentas. Similarly, such enzymatic activity in the fetal liver was also low. We conclude that chronic maternal addiction does not induce metabolic pathways in the placenta for the biotransformation of drugs of abuse.

Biotransformation↗
PubMed1989

Classification of twins and neonatal morbidity.

Prematurity is the most significant determinant of neonatal morbidity among twins, but the relative importance of other factors is unclear. We compared the prognostic value of intrauterine growth retardation, discordancy, and other classifications in 131 consecutive sets of surviving twins. A four-factor model for neonatal morbidity was developed from 161 potential outcome measures. Individual evaluation of each twin for intrauterine growth retardation using singleton growth curves was more effective than discordancy and other classifications in predicting neonatal morbidity. Our findings suggest that evaluation of twin growth should concentrate on individual twin growth rather than discordancy. These results also speak against interpreting growth curves based on twins in the same way as growth curves based on singletons; it is apparent that the frequency of growth retardation with associated neonatal morbidity is increased among twins.

Birth Weight↗
PubMed1987

Does intravenous ritodrine therapy cause capillary endothelial damage?

The effects of intravenous (IV) ritodrine therapy on capillary endothelial damage and colloid osmotic pressure were examined in 15 patients in premature labor. Plasma fibronectin, a marker for capillary endothelial damage, did not change significantly after IV ritodrine therapy. Plasma colloid osmotic pressure was lowered following ritodrine therapy (P less than 0.05). Pretreatment plasma fibronectin levels in the study and control groups were similar. Interestingly, pretreatment colloid osmotic pressure in the study group was significantly lower than that of the control group (P less than 0.05). Our data suggest that there is no evidence of capillary endothelial damage following ritodrine therapy. Lower levels of plasma colloid osmotic pressure in patients with preterm labor, which are further reduced with IV ritodrine therapy, may predispose these patients to pulmonary edema.

Adult↗
PubMed1982

Maternal alcohol use and infant development.

A prospective controlled study of the effect of fetal alcohol on infant development was performed. Twelve infants were identified as possibly having fetal alcohol effects based on the maternal history of alcohol abuse and the neonatal physical examination. Physical characteristics, growth, and development of these infants were compared with those of 12 control infants at birth and at a mean age of 12 months; control infants were matched for gestational age, sex, and race. Data were evaluated by descriptive statistics and analysis of differences between matched pairs of study and control infants. The results showed a significant correlation between the history of heavy antenatal maternal alcohol use and delayed mental and motor development, physical abnormalities, and growth retardation in the infants. This study suggests that infants with fetal alcohol effects can be correctly classified at birth and their outcome accurately predicted.

Abnormalities, Drug-Induced↗